No Epidural for You, You Bad Girl
Posted by realityrounds on July 17, 2009
If you want to see a laboring woman go ape sh*t crazy, keep her waiting a very long time, or do not give her a longed for epidural. Yes there are many, many, many women who deliver in hospitals who want, really they demand, on having an epidural during labor. In fact, the majority of women request epidurals. Yet occasionally, this demand is not met. These women may be in labor for hours before they get some smack in their spine, or they may never get it at all. Let me explain.
Anyone who has worked in OB long enough has come across those days when the meconium is hitting the fan. Women lined up in the lobby. Women laboring in a triage room. Women delivering vaginally in the OR because all the L&D beds are taken. There may be a crash C-Section, where the woman is being put under general anesthesia, or there may be a woman hemorrhaging and being rushed to the operating room. During these crazy days, there are still your average run of the mill women in labor who need, want, demand, an epidural, and a woman in labor is anything but patient. Yet hospital staff must triage, or prioritize our care. For an anesthesiologist, when other patients lives our on the line, inserting an epidural is low on the priority list. An epidural is essentially an elective procedure. You don’t have to have one, and you are not guaranteed of getting one. Do you think the patients know that? Uhm, no.
Whenever I lead my unit’s birthing tours, invariably the subject of pain relief comes up. “How long will it take to get my epidural?” (number 1 question). “If I want a natural childbirth, can I change my mind and get an epidural?” “Do you validate parking?” (Parking rates can be really painful in the city). I always recommend to all my birthing tour moms to take a natural childbirth class, even if they want an epidural the minute they are in labor. I do not recommend these classes based on any philosophical or scientific belief that natural childbirth is superior, but on a realistic knowledge that you are not guaranteed an epidural. Let me say it again, YOU ARE NOT GUARANTEED AN EPIDURAL. Those are tough words to hear when you have your heart set on an epidural. I tell those moms to take a class on natural methods of pain relief, because you can not predict how your birth will go. Having some alternative methods of pain relief, like the jacuzzi tubs we have in every labor room (I call them the aqua epidurals), or using imagery,or hypnobirthing, or whatever, will give you back a sense of control over the pain. I have no idea how many of these moms take my advice. My guess is not many.
For those moms who demand epidurals and do not get one, it can be a very painful experience for the mom, her family, the staff, and the CEO of the hospital. A lot of these women feel betrayed and punished for not getting one. We will often receive complaint letters from moms who were denied an epidural, for whatever reason. The feelings of being punished is exacerbated when staff respond to the woman’s complaints with “Well, you should not have come to the hospital so early.” or “Well, you should not have come to the hospital so late.” or “Well, you should not have come to the hospital.” Word of advice, blaming the patient for their health care outcomes is never helpful.
I am in no means criticizing these women for feeling betrayed or punished by the hospital for not getting an epidural. If we are advertising and promoting a pain free delivery, well, we are basically lying to them. A pain free delivery is never a guarantee, even with an epidural. All options for delivery need to be explained to women, before they enter the hospital in labor. It may be a conversation they do not want to hear or believe, like an epidural is not guaranteed, but it is an honest conversation.
*BTW, we do validate parking.*
RR
midwest woman said
wow did not know that..thought it was an amendment like free speech or something
realityrounds said
Are we really guaranteed free speech? But yes, there have been times, not many, that a patient could not get an epidural because the anesthesiologist was too busy.
pinky said
I agree. You never know when you cannot get an epidural.
realityrounds said
Yes, and women need to know this.
mitchsmom said
You are so right!!!
Sometimes I feel like our MD’s make the patients think it’s a 100% guarantee when they talk to their patients during prenatal visits & that is NOT always the case!! They could have low platelets, anesthesia could be caught up in a case, they can progress too quickly, it could be done and not be 100% effective, etc. etc. on & on…
I wish they would lay out the truth so the patients have realistic expectations!
Everyone needs to know how to cope with contractions on their own, even if it’s just for a little while, while they are in early labor or waiting for the epidural.
Most of our patients who want it, get it, and it works well but it’s NOT 100% guaranteed!
realityrounds said
I have seen that also, the doctors “guaranteeing” their patient an epidural. When they do this, the patients then get mad at the nurses, like it is our fault. Our patients almost always get an epidural if requested, emphasis on almost.
Ladydilee said
I remember at the birthing class I took for my first child, the nurse described to us a woman who had absolutely no prep for pain management because she was going to get an epidural ASAP. When she got to the hospital, the staff discovered that she was in the middle of a shingles outbreak….and she had a lesion right where the epidural needle needed to go through to her spine. Needless to say, there was no way they were giving her an epidural. It just reinforced a philosophy that I have heard several times (I think it is attributed to Ben Franklin), “Prepare for the worst, and if it happens, you are prepared. If something better happens, you will be pleasantly surprised.”
realityrounds said
Yikes. A shingles outbreak. Now I am going to have to look up the neonatal complications of maternal shingles.
Thanks for the comment!
M'Lynn said
GAH! A shingles outbreak. There’s another thing to worry about. I wonder if they put that in “What To Expect When You’re Expecting” or, what I call, “How to Be Alarmed When You’re Expecting.”
Akiko said
Shingles. something to think about when you dont get the chickenpox vaccine for your kids.
LizaM said
Or something to think about if you DO get the chickenpox Vax for your kids.. Yikes!
Erin said
I wanted a natural childbirth, I THOUGHT. Until I allowed my CNM to induce me 4 times with Cytotec, and my contractions went from zero to 4 minutes long with a 30 second break in between. Then, the anesthesiologist started looking pretty dang good. I lurved him. Seriously, my husband says I gushed for about an hour about what a great guy he was after he placed the epidural, and I think he said about 30 words to me. I’m still a little embarrassed about that.
M'Lynn said
Erin,
We knew we were having a girl, but after I finally got my epidural, I told the CRNA who did my epidural that I’d name the baby “Charles” after him if the baby turned out to be a boy. Don’t be embarrassed.
TheFeministBreeder said
Getting induced is not having a “natural childbirth.” One drug often necessitates another drug (especially induction drugs – I cannot imagine tolerating those unnatural contractions without being numbed from the nose down.
erin b said
At my wicked-busy hosptial, I try to counsel my (especially multiparous) moms that babies don’t always wait for the epidural. When all our providers are tied up with stat c/s, I’ve been known to tell patients that the reason they are waiting is because a baby needed its life saved. Usually works, but I have received the rolling of the eyes. I agree that every expectant mom needs NCB coping skills just in case.
Julie said
It’s a tough thing for me orchestrating the timing of getting the anesth. doc in.
I always give my patient their pain management options and then give them the power to tell me when they need something. I feel it undermines their confidence to constantly be asking “Are you still okay, do you want something for pain?”, just because they are grimacing or moaning or even crying. They know they can say the word and I will get them what they need… or will I? I give them the information on how long it will take to get pain relief when they ask.
I usually don’t mention to them that the anesth. doc may be tied up in surgery or with other patients and that they may have to wait hours once they do ask. I’ve always felt that would make them feel anxious. But,maybe I should.
realityrounds said
Julie,
It is a hard conversation. If you say it MAY take hours, patients may panic and get the epidural earlier than they need. I generally say it is rare that they will not get the epidural in a timely manner or at all (because it really is rare).
Akiko said
Stadol sure took the edge off when I was waiting for my heavenly epidural. Ask for it by name!
Naomi said
I did not enjoy or benefit from stadol at all……any pain medication is not guaranteed to work the way you want it!
and by the way, Akiko regarding your chicken pox comment
http://www.news-medical.net/news/2005/09/01/12896.aspx
I am not anti-vaccine (my son has the full work-up) but it does seem that getting ‘wild’ chicken pox does lesson the amount and severity of shingles…. so even if you don’t agree with that it is disputed enough that it might be worth to avoid being flippant towards those who chose not to get that vaccine.
realityrounds said
Thanks for your comment Naomi,
I always wondered how it would feel to have Stadol during delivery. Most women say it “takes the edge off”, but they still feel the pain. That has to feel weird.
Maggie said
By the time I had my epidural, I’d had IV drugs which just made me feel like my face was taking a vacation and was roughly located 6 inches to the right of where it actually was, and I’d been dialated to 7cm for over 12hrs. (long story, but once I got to the hospital, my nicely paced labor stalled COMPLETELY – ARGH!), and was SO tired I begged for it to be over. Well, once I got my longed-for epidural, it wasn’t fully effective. Only about 1/2 of what was supposed to be numb was, so just because you get an epidural doesn’t mean the rest will be cake!
Dou-la-la said
Thank you for this! I started replying via comment, and it eventually became its own post.
http://dou-la-la.blogspot.com/2009/07/childbirth-ed-why-bother-im-getting.html
All props to you!
realityrounds said
Thanks
Dou-la-la (great name btw).
enjoybirth said
This makes me think of my friend who I offered her a free seat in my Hypnobabies Childbirth Classes. She wasn’t interested. She had a very FAST birth and didn’t have time for an epidural. She freaked out for about 15 minutes, refusing to push because she couldn’t get the epidural. She finally pushed, the baby came out and she felt that awesome NCB high! She said had she not freaked out the baby would have been born 15 minutes earlier. She enjoyed the fast recovery and the NCB high.
I said, “Maybe you can take Hypnobabies next time.”
Her response? “I am just going to get to the hospital faster next time.”
Hmmmm, where is the logic in that?
What if you can’t get an epidural? « Woman to Woman Childbirth Education said
[...] several plausible reasons why your epidural might be delayed, read this post. There are many others, including some that I don’t know about, and others that I have heard [...]
Out of Touch with Childbirth and Women « Reality Rounds said
[...] on childbirth and just relying on an epidural is a dangerous game to play, as I have written about before. I have no clue as to waht the demographics are of the people who read In Touch Weekly. If the [...]