Should drugs (including epidurals) be available up until a certain point in labor?

[beautifulbirth]

Just had a client get an epidural with 15 min. to go and thought to myself...hospitals shouldn't be allowed to offer epidurals when moms are complete or close to it. I know why narcotics aren't offered late in labor, but does anyone think there should be a limit on epidurals? Or does anyone's hospital already have a policy like this?

[JerseyJess]

Some nurses/doctors will tell a women that it's too late for meds, but most (in my experience) won't. Even when a woman is complete they will sometimes say that it could be another 2hrs before the actual birth or this way mom can nap a while and let baby descend on its own.

I have mixed feelings about having a cut off. My concern is that if women are told they cannot have anything after 8cm, they will routinely be getting them early out of fear of missing their opportunity rather than out of actual need.

I'd rather have mom focus on one contraction at a time than constantly be worried with thoughts of "what if it gets harder and it's then it's too late' I do tell my clients that it is normal for a woman to doubt herself late in labor and if pushing seems imminent I will encourage her to hang in there. I've had 36 (out of 56) unmedicated hospital births and staying in the moment is key.

[helpinghands]

I was told with my first that when I refused meds at 8cm/complete..that was it..no going back. In hindsite.. that was rather ominous.. sort of scarey for a mom to hear in transition too. I have had moms get epidurals at complete and pushing.. ugh.. I blame the OB.. the birth was actually going quickly and the mom was complete/pushing and the OB told her that she should get the epi because it could still be a few hours The OB said.. your water is still intact.. the anesthesiologist wasn't even at the hospital..he sped through traffic to get there.. hands shaking so bad he bust one of the glass medication tubes for the epi (there is NO WAY I would have let someone so shakey near my spinal chord!!) And the funny thing is.. that her bag of waters released as the glass tube broke in his hand..I think he was nervous But..mom got her epi and an hour and half of pushing later.. baby was born. I was pretty sure baby would have come quicker without the epi (second time mom.. third time/next time I doulad for her I actually caught the baby in the hospital because doc didn't get to the room quick enough when called..)

I really don't know why they push for drugs even so close to birth??

[tlcdoula]

Personally I do not feel we have a right to cut any woman off from something she wants because we do not know the extend of her background, her full situation, or why she feels she might need the epidural. Remember that sometimes the mother who has been abused might need that epidural to remove the sensations and fear surrounding something coming out of her vagina as it might remind her of something going in that she didn't want. I think if a mother goes throughout her whole labor it would be great if she didn't, but remember there are situations that we do not all fully comprehend that could be going on (unless you have lived through them and then you might be able to understand and feel what she is).

Personally I think it would be inhumane of us to deny a woman something that she needs and risk causing her to suffer post traumatic stress. Now if there is a medical reason she cannot that is different, but if we are making a judgement by saying "hey you made it this far" then that is wrong and even more so then a doctor telling her she cannot have it. I equate that to a doctor who pushes meds. A mother needs to be educated and then be allowed to make the best decision for herself and her baby.

[tlcdoula]

Quote:

Originally Posted by JerseyJess Some nurses/doctors will tell a women that it's too late for meds, but most (in my experience) won't. Even when a woman is complete they will sometimes say that it could be another 2hrs before the actual birth or this way mom can nap a while and let baby descend on its own. I have mixed feelings about having a cut off. My concern is that if women are told they cannot have anything after 8cm, they will routinely be getting them early out of fear of missing their opportunity rather than out of actual need. I'd rather have mom focus on one contraction at a time than constantly be worried with thoughts of "what if it gets harder and it's then it's too late' I do tell my clients that it is normal for a woman to doubt herself late in labor and if pushing seems imminent I will encourage her to hang in there. I've had 36 (out of 56) unmedicated hospital births and staying in the moment is key.

I totally agree - you start telling women there is a cut off and they will ask for the epidural when they enter the hospital for fear that they will miss that cut off!!

[UtahDoula]

Absolutely not - I'm against anything that restricts mom's right to choose.

[helpinghands]

I don't know if I think this thread was anti moms choice. What I really dislike.. is when mom is nearly complete and Drs/nurses still try to PUSH meds. It is a very hard work time for mom (transition) and I feel like moms can be very open to suggestions without thinking them through when they really are so close. AND.. those drugs do have affects.. so if a mom asks/choose the meds.. that is one thing. A Dr./nurse bringing it up like that..well.. that is another ball of wax to me.

[herbalmama]

with my first birth, I was complete, pushing and she was crowning and a nurse came up to me and reminded me in a sing songy voice "it is not too late...."
All I thought was.. by the time I could get it, I don't want to still be pregnant! She was born within 10 minutes....

[HamiltonBirthRevolution]

I usually cover this in prenatals and I've written an article about late epidurals.

Except in certain circumstances (labour dystocia that would benefit from a more relaxed mom or stalling or a women with history of sexual abuse...) I really believe the evidence is there that late Stage 1 epidurals have negative impacts on Stage 2 which can lead to raised risks of morbidity and mortality for mum and baby during Stage 2 and beyond.

I talk about this with mums and partners in prenatals and in CBEs so they understand really well how birth happens physiolgically without and with outside factors. Then I get a really good idea about what mum really wants, put that down in the birth plan and if mum starts caving or panicking in transition, we review what we discussed.

While I don't want to impede a woman's right to choose, I do want to serve as that one person in the room who is paying attention to what mum really wants and help her make a decision informed by more than a momentary panic brought on by an adrenalin rush. In my experience, nurses and docs don't care about consequences or true informed consent and will blithely hook mums up to epidurals at the first hint that mum might be thinking of one. I don't think this is very good medical care.

[missilla]

i understand why some would say yes, but i totally disagree. the whole birth process should be the way the women wants it. i think that women should have the total abitlity to choose when, how and why. if they start making restictions on when and how a women gets pain meds what else is to follow. we want to take the technocratic model out and put the power back into the mother. she knows what she needs and wants. we can give her support and help but in the end she knows what is best.

[HamiltonBirthRevolution]

I agree, and disagree. While I think it's important that women have choice in birth, introducing meds in labour is a medical thing that is supervised and administered by highly trained doctors and nurses. It's not like choosing to labour in water or labour upright or eat during labour or something. The physiology of labour is supposed to work in a particular way. When you introduce meds into that normal physiology you begin to change and derail it.

And, I also believe that epidural use is focused far too narrowly on the mum and her comfort level/right to choice. She isn't the only person being medicated. Few women stop and think about the baby and it's needs. Since epidurals can impede the release of certain hormones linked with efficient birthing and breastfeeding, the baby loses out or is subjected to a birthing process that is suddenly impaired by med use.

So, while I want women to make their own choices in labour, I also want to them to be better informed and committed to making decisions in labour that reflect more than just their immediate comfort factor.

It is physiologically normal for women to freak out in transition, for it to feel as if it is unbearable, for women to feel out of control and ready to be done with the process. Getting an epidural to treat those symptoms is short-sighted in normal labours, IMHO.

If a woman honestly wants to make a change in her birth plan, fine, I'll support that. It's my role to help her make sure that's what she really wants. But, I don't think drugs should ever be offered to a labouring woman in general (outside of non-normal circumstances) - that starts to erode a woman's ability to choose her own birth as we all know how vulnerable birthing women are.

[loveslabor]

Short answer- no, I don't think there should be any cut off.

[earthgirl]

I am all for a woman choosing meds/epidural if that is what she wants, it is her birth after all. What I often wonder is -what is the hospitals agenda in offering the epidural so readily, even if the mother requests to be supported by not being offered any meds? I had first hand experience where the mom really wanted to go natural, and did not want to be offered any meds, that she knew her options and would ask for it if she needed it. Well the OB sarcastically snapped-If they offer it- just say NO! She totally didn't understand why she didn't want it mentioned. I found it quite disheartening, and very unsupportive.
Another thing, I don't know about all hospitals, but I know one in particular where they have staff GOALS!!! Including # of cesarean surgeries, and admittances to NICU. The goals were not to decrease the # but increase! They are a business and anesthesiologists would not have the careers they do without epidurals. So I think they do push it on clients, and not always because they compassionately want mom to have some relief. That is just my honest opinion.

[loveslabor]

Quote:

Originally Posted by earthgirl I am all for a woman choosing meds/epidural if that is what she wants, it is her birth after all. What I often wonder is -what is the hospitals agenda in offering the epidural so readily, even if the mother requests to be supported by not being offered any meds? I had first hand experience where the mom really wanted to go natural, and did not want to be offered any meds, that she knew her options and would ask for it if she needed it. Well the OB sarcastically snapped-If they offer it- just say NO! She totally didn't understand why she didn't want it mentioned. I found it quite disheartening, and very unsupportive. Another thing, I don't know about all hospitals, but I know one in particular where they have staff GOALS!!! Including # of cesarean surgeries, and admittances to NICU. The goals were not to decrease the # but increase! They are a business and anesthesiologists would not have the careers they do without epidurals. So I think they do push it on clients, and not always because they compassionately want mom to have some relief. That is just my honest opinion.

A little off topic- but speaking to "goals" and quotas.....one of my midwifery teachers told a story about when she had a hospital transport and an OB there, (who was quite helpful to her and her clients when transport was necessary) once again had done something nice for one her transport clients. When this midwife thanked him for his help, he said something like "If you really want to thank me, bring me a hysterectomy."

Now, not because he wished that on anyone, but because he had quotas to meet. Goes to show what priorities are sometimes.

[Acacia]

If a mom is so far progressed the hospitals here won't do an epidural. Most of the time she can't hold still enough or there just isn't enough time. I don't think they should take the option away though...If a woman says she wants it and has not made any firm rules to her support team about not getting any pain medication then I think she should be able to get what she wants. If the mom has made a true effort to let her support team know that she does not want pain meds even if she asks for them then I think that is different. If she knows she doesn't want them even when asking and someone comes in and pushes I think that is wrong but if she has never said anything about her wishes and asks and it is offered I don't think she should be ignored to have the birth she wants to have.