WOMENS-HEALTH Messages for October, 1998: Re: Another queston on epidurals

Re: Another queston on epidurals

From: Suzanne (anonymous@obgyn.net)
Mon, 26 Oct 1998 08:12:46 -0500

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At 06:48 AM 10/26/98 -0600, anonymous@obgyn.net (Sam) wrote:

>I have been a nurse in an NICU for 15 yrs. at a busy hospital, where we
attended all deliveries, and let >me reassure you that having an epidural does not make the nurse's job
easier. They assist with the >procedure, have increased duties with watching v/s, may need to cath. the pt. if labor is prolonged, and >may have a pt. longer if the epidural takes a long time to wear off.

It is actually more than a few L&D nurses who have said to me that it DOES make their job easier, most of the time. Yes, the patient needs to be monitored more closely, but that can be done from the nurse's station or another patient's room, thanks to the wonders of technology. With an epidural in place, much less is expected from the nurse by the patient, also.

>Unfortunately in the name of cost
>control it is unlikely that there can be a 1:1 nurse/pt. ratio so the
nurse may have a very limited time to give >all her tips for pain control, although they have many. It is imperative that a woman know she will not be >able to solely rely on a nurse as her labor coach and have her significant
other be very informed.

There has been research done that shows that even in cases where the is a 1:1 ratio, the nurse still spends less than 10% of her time doing actual labor support. And this is sad, really, as many of the L&D nurses I know went into that field thinking they'd have more hands-on time with the patients.

>I have
>also seen many situations where having an epidural in place has made the
delivery of a baby so much >more enjoyable for the couple and situations where it was lifesaving to an infant when an emergency c/s >is needed- for example for very low heart tones! > or when a loss of fht's occurs.

Yep, I agree with you that it can be a great thing. I am glad that we have it available for those situations where it makes for a more positive birth experience. But even in the situations where you describe it makes it more enjoyable for the couple, it is not necessarily the case that only an epidural could have done this -- though at the point that it is done, the point is moot because the options may be limited then.

>IMHO the prenatal classes I attended-I have had 3 births- would never
>adequately prepare a labor coach for a 20 hr. grueling, mud slinging, back
labor, lose your sense of >humor birth. (granted all are not like this but many are).

I totally agree with you on this point. Even the classes I teach, which I know are much more in-depth than most offered in this area -- it is still not enough. Hence the need for doulas!

>It's also a misconception that if a woman has an
>epidural she won't feel a thing and can' tell how to push- in experienced
hands it can do as little as take >the edge off!

Unfortunately, not everyone can count on "experienced hands." There are still many, many places where the only option is the classic, body-numbing epidural. And that leads to not being able to feel to push. Even within the same hospital there may be some that will do lighter epidurals and some that won't. And this is why, in the classes I teach, I thoroughly cover the various types of epidurals, so that the women can make informed decisions and ask for what they want. Even if the type of epidural they want is unavailable, if enough women request it, the doctors will start offering them (born out at our local baby factory hospital -- 1200 births/month -- where the head anesthesiologist said exactly this happened "The childbirth educators started teaching about other types of epidurals, the patients started requesting them, and due to consumer demand we had to learn how to do them.")

>After a 23 hr. pitocin, back labor, mid forcep deliver the placenta in
trendelburg experience I >was grateful for a late epidural that made it bearable for me.:)

And I'm glad it was available to you!

****************************** Suzanne S. Powell, ICCE, CD Childbirth Educator, Doula, Student Midwife

-- Peachtree City, Ga.

Partum Me! Educational & Support Services http://partumme.hypermart.net/partumme.htm ******************************

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