labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, September 5, 2007

Demands, Demands

For those who have read me back in the good ol’ days (aka Life & Times), you know one of my biggest pet peeves are those who must have an epidural yesterday. You know, labor and birth are as old as dirt so I can’t imagine any woman these days who didn’t know going into this that labor was going to hurt. Hello, people! What were you expecting?

I recently was asked (or rather, demanded) when was “my epidural was getting here?” Huh? I didn’t realize it was on order. And by the way, when you say “your epidural” you must mean the human being that was highly trained commonly known as the anesthesiologist to place said catheter? Um, ya, she will come give it to you when I can safely prepare your wussy ass for this intervention.

Ok, so I didn’t really say that. What I really said was something like this: I need to do several things to get you prepared for the epidural. First I have to start an IV and run a liter of fluid into you. However, I can only run that liter of fluid over 20-30 minutes, at the most, because too much fluid too fast can cause problems. We also have to get the results of your blood count, because an anesthesiologist will not place an epidural catheter until they know what your platelet levels are. Your labs were ordered stat so I hope to get the results in 30 minutes. I’m doing my best to move things along so you can get an epidural.

Needless to say, irony has a funny way of working itself into these sorts of situations. Well before anything was ready, this woman became fully dilated. She fought and argued that there was no way she was pushing without an epidural. “I can not do this without one!” is what she yelled. The doctor said something like, “Well, you have no choice.”

Now, had the attending been someone else, say one of the docs who isn’t so forthright, she would have got the epidural. I have seen some who fight their body’s own natural urge to bear down so that they can get an epidural. In the time it takes to prep them, get the epidural in, and then for the time it takes to work, they could have had a baby, breastfed, and taken a nap already.

But hey, to each his own, so they say. Unfortunately for her, this woman did not get what she wanted but she did have a baby 10 minutes later, and spoke nothing of the epidural after.

p.s. before you all get your noses pushed out of joint over “wussy ass”, keep in mind that this was being asked by a woman who came in in early labor and was still able to talk and breathe easily through contractions. We originally thought she was going to be one of the women that would be sent home after having confirmed false labor.


Redspiral said...

The "wussy ass" comment made me laugh out loud. ;)

Misha said...

seems like all women I know PLAN the epi with the blessing of physician when they schedule the whole thing. Here in the midwest the docs call the shots. Everyone I know is induced. Personally, I have had to be induced twice (for real reasons--preeclampsia) and went naturally once. I never had an epi with any---not because I am so brave, but because I was afraid of complications--but the pain was certainly worse with the 3 week early induction 7 pounders than the 9 pound "au natural". Until physicians can work it out so they aren't in such a hurry to git-er-done and women insist on advocating for their babies...I think you will see more demanding behavior.

BrooklynGirl said...

Yikes, as a patient, I have to say that I find this post my worst nightmare.

When you're in pain, of course you want relief. And I don't know anyone in pain--whether that's labor or not--who can calmly wait for that relief to come. (Channel, for a moment, Shirley MacClaine screaming for her daughter's shot in "Terms of Endearment.")

And, yes, as a woman who got an epidural when dilated at 3 cm, "wussy ass" does offend me.

Labor Nurse said...

I'm not saying that this woman should not have had pain relief if that is what she wants. What I have a problem with is the demands and expectations of "right now". The stomping your feet like a toddler without any regard to safety measures irritates me.

Many women measure each other up by how long they were able to "hold out" for an epidural. Kind of like how guys compare penis size. But I don't care when a woman gets an epidural, whether it be at 3cm or 8cm; I say wussy ass because the toddler like behavior when told an epidural not going to happen right then or the yelling and screaming that "I'm not going to do it!" is ridiculous. I just can't imagine myself thinking that I was going to not feel a lick of pain or be some exception and have the nurses and doctors overlook the preparations that precede the pain relief. This expectation that you can have anything when and how you want it in our culture has crossed into many women's expectations when they walk onto our unit (and all other L&Ds).

Amy said...

I hear you on the irritation. I once had a patient tell me she was going to file a complaint because she had to wait an extra 30 minutes for her pain block because anesthesia had to get an emergency trauma case going in the main OR before they could come down. I understand that people want their epidural but having it for L&D is a luxury not a necessity for most of our patients.

PE Mommy said...

Hmmmmm, my initial reaction was worse nightmare too. But, I can understand what your saying about the now thing. But realize it could be a panic thing too.

My first, severe preeclampsia and partial hellp syndrome (platelets were the ONLY thing ok). I was told I HAD to have an epidural before labor started because they wanted me in no pain because of my bp. I was having an emergency induction. So after 2 rounds of gel and nada. No csection because they were afraid I would bleed out or seize, they did a manual ripening with a foley. Worst experience ever and extremely painful on a very posterior and very unripe cervix. They gave me a shot of stadol and fentayl, I felt better and slept the afternoon away (might have been the mag too that made me so tired). Anyway, 4pm, anesthesiologist came in. Got the epidural. They said time to start labor. Never felt a contraction. This was in Belgium. None of my friends got the epidural because they go all natural there and it was too late for each of them.

Imagine MY rude awakening with my second. Another emergency induction. Sent from the peri's office to my ob because I "looked" really bad and my bp was very high on 2000mg Aldomet and 60mg Procardia. I had all the visual, headaches, swelling, upper right pain too. Get in. No ripening. My dr didn't even check me till the nurse said dr, don't you think you should check her??? 1cm 50% effaced at 35 weeks. Hmmmm. Started pit. This was at 3pm. He was in and out checking on me. At 833pm, I was checked again because baby had decels. Surprise 3cms. I really wanted that epidural pretty much when I came in. The midwife for my doc comes running in with a nurse, flipping me around, putting on O2. Then said she needed to put an internal monitor on. I had forgotten that meant break your water. She breaks my water without telling me what she was going to do. I freak out because the last time that happened, my daughter was born 30 mins later and only because they made me wait for the nicu and the nurse didn't beleive me (I went from 5-10cms in one contraction when my water was broken and have my medical chart to prove it!). SO I pannicked. I thought OMG I don't have an epidural. I did NOT intend to go natural and you have broken my water. She takes off running out of the room. I call after her where are you going. She says to get that epidural. The anesthesiologist was called in from home. An hour later he shows up. I was 3 cms at 833pm. I get the epidural, which does NOT work. I am checked 7-8 cms. OH CRAP. My daughter came flying in at 11:40pm. Guess what, my doc didn't believe I would go that fast either because at 11:33pm, he ordered a shot of Demerol through the iv. I didn't ask for it. He ordered it. But when it was ordered, I said please put it in fast. This was an induction. Imagine if I had gone naturally!!! They pretty much told me to park it at the hospital next time.

Anyway, I never expected that the epidural would not work. Now I totally know it doesn't. But I know I could do it if needed to even though I prefer the epi. Oh and my doc used some medicine when she crowned. BEST STUFF EVER. All I felt was her little head pop out and pressure. No pain. I did tell him to stop while he was applying it because I didn't like that. He ignored me and did it anyway, lol.

But anyway, sometimes people might have that expectation because of a prior experience. I never felt a contraction with my first, so it was such a rude awakening with what happened with my second.

Labor Nurse said...

pe mommy, your birth stories remind me that many women have your very same expectation if the first epidural worked beautifully (or they heard how well it worked for their sister or friend) and the subsequent one doesn't work well or at all.

There are so many variables and each birth experience has unique features. But again, in the situation I originally described I felt the demands a bit overboard.

Anonymous said...

i disagree with so much of what you write on here, but your opinion is your opinion (just like mine is mine) and i enjoy reading your thoughts. i expected a lot of pain, but i don't think anything can prepare you for the intensity of the pain of labor until you feel it for yourself. have you had this experience yet?

Labor Nurse said...

anonymous, I am assuming that you disagree with this particular post, which I'm actually quite surprised more people didn't. I can see where you are going with your question of having been in labor myself (no, I haven't) and I will tell you that I have no problem with women wanting an epidural whenever they want it; again it's the obnoxious demands of right now, I don't care if there is a person dying in the OR, get that anesthesiologist here now! attitude that pisses me off. I could go on and on about how, despite knowing in advance that an epidural is in your plan, that laboring women need to be prepared with other coping techniques to use in situations such as this. Herein lies the value of prepared childbirth, even if you only use comfort strategies and breathing techiniques for 45 minutes or however long it takes to get an epidural and for it to work.