Thursday, October 9, 2008

Keep Teaching Me!

Wow, ok, I have been totally blown away by the awesome, amazing comments that have been left on my last couple blogs answering all my questions. I feel like I've learned more by reading comments from REAL moms who have done AMAZING things during their child's birth than I ever could have just by asking other nurses what they suggest. Thank you so much for all the tips and suggestions. I've ordered/looked up some of the books that people suggested, so now I'm really excited!

I think my perspective has totally changed on natural childbirth. I have felt like a horrible nurse standing there watching my patients "suffer" and "hurt" when I guess I can almost compare it to a good work out: no pain no gain, and how much more you appreciate something after your work for it. Not that you don't appreciate your baby immensely after you deliver no matter if you had pain meds or not, but those of you who can go without medical pain relief...you amaze me!

Next question (then I'll lay this topic to rest, for awhile, so I don't bore people who read this...): 2nd time moms...from what I've seen, 2nd baby labors are a lot different than 1st baby labors, simply because your body has done it before. So, those second time moms who come in planning on getting an epidural, is it ok to really encourage them to get it before their pain is unbearable, or does that cross the line of forcing it on them. As I nurse I really do feel that it's my worst nightmare to have someone WANT pain relief/and epidural and not get it because she goes from 3cm-complete in 30 minutes. I feel the worst for the multip mom's or even prime mom's who come in very far dilated, and there's no time for an epidural and they really, really want one. So, is it best to "strongly encourage" mom's who have said they would like one at some point to get a block before it's too late, or is it better to wait until they really "need" it? Keep those suggestions and comments coming...this is way better than sitting in a seminar all day trying to learn what a book suggests! :)

Funny, I work again tomorrow and I'm actually kinda hoping for someone who might want to go without pain meds, to see if I can put into practice what everyone's been suggesting.

11 comments:

  1. Another L&D nurse here-no, don't encourage them to get it before the pain is unbearable. They know it is there, they know to ask for it when they want it. I always tell them "Don't wait until you think you are going to kill someone if you don't get one right now. From when you ask til when you get it is approximately 30mins to 1 hr depending on unit circumstances"

    I've seen some people who thought they wanted an epidural, went too fast to get one, and then they were so proud of themselves that they did it without.

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  2. Don't "strongly encourage" but don't drag your feet either. After my first son was born, when I got bit by the "birth junkie bug", I started trolling the 'net looking for "bad birth stories" to try to figure out why women had such bad experiences when mine was so empowering. Most of the stories I read were of women who wanted a natural birth and were undermined, but there was one that was completely different. In her first birth, this woman had asked for an epidural, was told she wasn't dilated enough, then progressed quickly, and was told she was dilated too much. When she went to the hospital for her second birth, she told her nurses the story, and said she didn't want a repeat. Well, she had a repeat, and she was absolutely **furious** that she had had a natural birth when she wanted an epidural.

    Maybe you can ask each mom as she's getting settled into the hospital how important her preferences are, as well as explain the protocols and parameters of when she can and cannot get an epidural. If your hospital has a policy of no epi after 7 cm, then you can tell her that, as well as how long it usually takes to place an epi, and then as you check her dilation, tell her where she is, so she knows, "Ok, I'm at a 6 now, so I should probably get an epidural if I want one."

    But honestly, birth was the easy part -- labor was the hard part, for me. Maybe if I'd been pushing in stirrups I'd've needed something, but I don't really know why women would get an epidural to avoid the birth sensations but not get one to avoid the labor sensations. Being able to push out the baby is powerful! Feeling helpless because the contractions are hurting your back (at least, that's where I felt most of the pain in both my labors) is... well, *powerless*. If you phrase birth in a positive way, women may be encouraged to try natural birth as well as natural labor. Yes, I had "the ring of fire" but it didn't even last as long as one contraction, so it certainly wasn't worth getting medicated for.

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  3. I haven't had meds, but I would say not to wait too long as the second/third times can go pretty fast. If she wants pain meds, and is far enough dilated to have them, I'd remind her to ask before it gets too late if she's wanting them. I will say that I've found as a mom to many, that my labors changed at the 5th and the labors actually take longer (similar to first time but not quite as long). And if baby is OP the pain is more difficult and it takes longer to get to the true pushing stage.

    I'm no expert on pain meds though...

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  4. This is such a great idea...asking questions from experienced moms! I am in the process of getting into nursing school, one day being in L&D, so this has helped me a lot. It's nurses like you (who care) that inspire people like me. I was a teacher for five years and after having two little ones of my own, positive experiences in L&D inspired me to seek this new career. I am more than excited to get things going so I can soon be where you are! I think the questions are wonderful. Keep asking if you've got em!

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  5. Hi, thanks for asking these questions. I can tell you are going to be an awesome nurse.

    I haven't seen a comment from someone who tried an unmedicated birth but ended up with a c-section.

    Quick synopsis of my labor: I took a nap at 2:00 pm on Monday and was woken up several times with painful contractions. Between then and 1:00 pm on Thursday when the baby was born I had only 4 one-hour naps (that were all interrupted by contractions).

    Wednesday night I went into the hospital (very sleep-deprived) with contractions 3 minutes apart and was surprised to discover that I was only 2 cm. I progressed to 5 cm within two hours so they admitted me.

    Even though my labor never slowed down (contractions 2 or 3 minutes apart all night long and more than strong enough to get the job done according to the internal monitor) I never progressed beyond 5 cm.

    After 12 hours stuck at 5 cm and side-lunges and squats until I collapsed I asked for a c-section (I decided that I didn't want to wait until something went really wrong).

    It was still one of the most amazing experiences of my life. I will cherish it.

    Things I loved:
    -Marci (my nurse) told me everything she was doing before she touched me
    -She also said, "I am not going to offer you any pain relief at all. I won't speak of it again, but an epidural is available whenever you want it.
    -Marci acted hopeful that there would be progress even after 8 hours stuck (then there was a shift change).
    -My OB said after it was all over, "You are one tough mama."

    Also:
    -All the natural childbirthing books say that pushing is way less painful than transition. My friends who have had episiotimies (sp?) without drugs said they couldn't even feel it. So if your patients made it that far without the drugs then they are in the home stretch.
    -It was frightening for me to see my nurse change from friendly, warm L&D Nurse Emily to OR Nurse Emily with her cap and mask. I don't fault her for it at all; she had a lot to do. It might have helped, though, if she had paused for a few seconds to say something encouraging like, "everything is going to be fine."
    -I wouldn't freak out too much as a woman waits for an epidural, especially if there is nothing you can do about it. Just knowing it is coming is a relief. Being in labor for me was like being in a time warp. I had no idea that everything took so long. Apparently I waited 45 minutes for Emily to answer my call that I wanted a c-section (the nurse who took my call forget to tell Emily). Then I had to get 1 L of fluids before the epidural and then they could start prepping me for surgery. I didn't feel like it took that long at all.

    Sorry I wrote a novel!

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  6. I do the pain management talk when I admit my patients. I present all options available, and answer any questions they have. I let them know when they can have the pain medications/epidural/paracervical blocks. Then I tell them that unless they ask me questions about pain management, I will not mention pain meds/epidurals again, unless they ask for it.

    The most popular questions I am asked:
    -when is it too late to get an epidural? (answer: when the baby's head is coming out.)

    -is it too early to get an epidural? (answer: depends on if your doctor is a misogynist or not.)

    -how long does the epidural or pain medication in the IV last? (answer: IV med (stadol) lasts 1-2 hrs. Epidural lasts the entire labor/delivery.)

    -will the epidural wear off? (answer: no, but you will feel pressure as the baby moves down. Some women interpret this as pain.)

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  7. Most women I've talked to have said that their labor for second babies went quicker, and was also easier to deal with - I think because they had more of an idea what to expect, how to help themselves etc. So I would be careful about encouraging an epidural much just because, like another poster said, a woman who is "on the fence" about getting one or thinking she probably wants one might find that she does fine without and feels great about it.

    I will add too, that for my son's birth - first stage was not painful except for the last few transition contractions - between laboring at home, going to the hospital and getting in the tub, walking around some and the birth ball (started contractions at 10; picked up at 1pm; went to the hospital at 4pm; started pushing at 10pm), I was really able to keep on top of the contractions. Pushing him out was a whole 'nother story though - he was fairly big, with a 98% head circumference (8.5lb) *and* had his hand up by his ear. It didn't take that long (45min), and I was side-lying, curling way up on my side/hip to push (there was a grab handle on the bed that worked really well for me) - but it was hard work, and it hurt. So for me, dilating has always been much easier than pushing, even though I was in physiological positions!

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  8. My second baby had to be induced. From the time I had the pitocen started to delivery was only 3 1/2 hours. I had been planning to go without meds, and it's a good thing because I don't think their would have been time had I been plaining for an epidural. In my experience, the 2nd baby does come a lot quicker, but I wouldn't push a mom for meds. I would watch for signals and keep asking mom and warning that 2nd baby usually comes faster.

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  9. Oh, and if you think you've ticked off a patient...don't worry about it. Really. I was very angry with my nurse with my last baby. She did do some things that if I presented it from my perspective, yes, were mistakes (my OB even agreed and said she'd speak with her in a few weeks). I didn't want the nurse reprimanded or anything, I think she was nervous or newer. I really was mad at her, hoped I wouldn't see her after the birthday (and I didn't, thank God). Though I can still complain about her it may be justified, I do not feel she was completely terrible. If I had an epidural, half of what she did that bothered me would have been mute (like not letting me leave the bed to pee, or all the monitoring, or how the cervical checks hurt because she kept her fingers in there...). She probably was just used to medicated moms, and moms who didn't react to pain as much since they didn't have the same pain. She also didn't catch the OP position despite all her internal exams (and neither did the first OB who checked...baby was floating high). She did do some things right, and time has given me that perspective. When she found out baby was OP, she had all sorts of position change suggestions and helped me push in these various positions...which my husband says allowed baby to be born in about 10 minutes after trying them...and I had maybe one contraction every minute so that's a lot of position changes for a heavy birthing momma. I know I was impressed with her as she was small and helped me change positions. Wish she had done it sooner, but once she knew the picture she knew how to act.

    Basically, what I am saying is that time has healed me some with the opinion of this nurse. I recognize that I had some expectations that may not have been realistic. I wanted to go without an IV, but when baby had the decel, of course, nurse had to give me an IV. I wanted to move around, again, the decel scared her and I was tethered to that machine for the duration. The OB said I could get out of bed, and the nurse did try to put me on a birthing ball (ouch, it hurt more nad messed with the monitors). She tried to help me...and she stayed for over 20 minutes after her shift was over. She was with me from the time I was admitted until baby was born, leaving the room only maybe five minutes at a time...and not often. That says a lot about her willingness to be there for her patient. She just had a personality that didn't work for me when I was in labor, and I also couldn't get her to hear me and what I was saying. My expectations for a shower for pain relief were taken from me, and I believe the inflexiblity made my conflict with the nurse much worse.

    So, if you have a clash with a patient, know that if you are doing your best to keep mom and baby safe, even with mistakes...you will likely be okay. After a year, thinking about the nurse still gets me a small bit of anxiety, but I think it's more my problem at this point and not hers. She's likely moved on. I bet she's a better nurse for moms out there. I bet she learned something that day from me, even a little something. I can hope at least! And, I know I'm not damaged forever...I have a healthy baby and I have learned a lot about birth and options since then.

    Bless you for trying your best for moms and babies!

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  10. I'd say, are you offering the epidural to alleviate the woman's pain, or your own? Maybe an internal way to check on your intention when the urge comes up to offer... Hope it helps! :)

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  11. In my situation, I had every intention of getting the epidural and made it clear upon check-in to the nurse when she asked what the plan was. I was not aware, as it was my second child but the first one in which I was asking for an epidural, that I could get it anytime.
    The nurses were telling me how weird I was by just sitting up in bed and laughing through all of my contractions and we didn't realize how fast I was progressing. I was dilated to a 7 and the nurse asked me if I was going to want that epidural, UH YEAH!! I was giving her a hard time about not letting me know I could have had it sooner, I was looking forward to this pain-free birth everyone had told me about! Yeah, did not happen. When the anesthesiologist came to but the catheter in my back we discovered only one place that it could be inserted and I MOVED!! After a few more tries I asked him to stop and then looked at the nurse and said "I am going to have to go natural aren't I?" yes. I had not had any pain relief at all because I wanted to feel the labor progress for a while and go straight for the epidural. With my first delivery I only had narcotic relief through the IV and I didn't like it at all.
    Moral? You know when the patient is checking in how important the pain relief is. I know as a patient if that nurse had told me clearly that I could ask for the epidural at any time, I would have been able to get it. As it was, when the anesthesiologist was trying to insert the catheter in the one spot we had available, I was transitioning. Try to stay still for that!
    I am not angry at my nurse or anyone on that team however. I am in fact VERY happy with how that birth turned out. It is funny though, with my first child I wanted it all natural and was so tired I ended up with narcs just to be able to rest. With my 2nd I wanted to be totally numb so I could relax and enjoy the labor. You never know what you are going to get.

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