Related to shivering question

[lml33]

During labor, I experienced the same thing. I was shaking/shivering uncontrollably, but I was not cold. This was during labor, but before the epidural. What is the pathophysiology behind this? Does it have something to do with the sympathetic nervous system response to a great amount of pain. I was just curious, being that I have not yet taken advanced physiology or physiology for nurse anesthetists.

Another question. I was hypertensive with my first child, and during labor. The epidural was a great benefit because it lowered my BP on admission to the labor and delivery unit. Initial was 220/110 (that was the labor with the intense pain and shaking). But during my subsequent labor, my BP was in normal range. After receiving the epidural, my BP dropped to a systolic in the 90s, then to the 80s (at this time symptomatic with nausea). IVF wide open was infused, with minimal change in BP. Then anesthesia was called to inject ephedrine (which worked). Should I worry about the next labor, or is this a pretty easy thing to manage with ephedrine?

Something nurses can appreciate: When my BP dropped to the 80's with symptoms, I told my husband, "Just wait the nurse will be in sometime." After some time with no change in the next BP, my husband got the nurse.

I can't wait until I start the nursing anesthesia program, so all these questions can be answered. I like specifics, not just a simple answer. I think some may take it the wrong way when I ask questions that are simple (of which I know the answer), but I like the complex answer (the answer that explains the whole process). For example, I could ask, "What is Natrecor?" Another nurse would say, "Its for CHF." When I really want to know the exact action, what receptors it binds to, how it works, what are the pharmacodynamics, etc. I ended up looking on the Internet for the complete answer. Leslie.

[smiling_ru]

You may or may not have the same problems with your next epidural. Most of the time it is easy to manage, so I would not worry about it. But, I would let the anesthesia provider know of your last experience.

[Vsummer1]

I seem to remember that the shaking during labor was hormonal (that is, the shaking not related to the drugs).

[lml33]

Thanks for you time in replying. Leslie.

[Brenna's Dad]

I had always assumed that shaking during labor was secondary to sympathetic nervous system stimulation. Can anyone else give specifics?

[Tenesma]

there is no real answer regarding the shakes - but by most standards it is felt to be a hormonal response, and not related to sympathetic outflow.

the reason why your BP dropped with both epidurals is because of your loss of vascular tone - very normal reaction... the way to avoid it is to be very well hydrated... in obstetric anesthesia they talk about giving 1000cc crystalloid before epidural placement... some of the drop in BP is also due to vasovagal response that is present in some mothers.

the interesting thing is that there are more and more studies showing better management of BP with phenylephrine instead of ephedrine in pregnant women - which a few years ago would have been considered heresy