Today I saw an epidural insertion, which almost made me pass out. They use a four-inch-long fat needle which is curved at the end to aim the catheter up or down in the space outside the spinal cord. The anesthesiologist inserted the needle at least three inches in and wiggled and moved it around much more than I would've imagined possible, trying to find the epidural space. Meanwhile blood is dripping out the hole. She said she aims it up (toward the head) in first time mothers because she figures labor will be long, and aims it down (toward the butt) in multiparous moms because she figures labor will be short but more intense. She used the 'lack of resistance' to check the placement - she kept trying to inject air through the catheter until she was able to do so, at which point she knew she was there. It seemed like 10 cc or so of air - I wonder what happens to it?
The mom was so passive about the epidural in general. She didn't really want it, and later said she wasn't sure if she wanted it or not, and seemed really reserved. The nurses assumed she would get it eventually. In fact, it mostly happened because the oncoming day-shift anesthesiologist wanted to have the the night anesthesiologist do it, who was apparently sleeping in a room on the floor. So they kinda concocted the idea that the nurse would tell the patient she'd have the night doc "talk to her", and then page him to wake him up. The day doctor decided she'd do it after all, though, so they just kinda started doing it. I'm not saying it wasn't consent, and I'm not saying things like this don't happen all the time in the whole hospital, but it wasn't exactly informed consent. Then after the catheter was put in, the nurse informed her that she'd have to put a urine catheter in. I think I'd want to know that beforehand, since most women I know who've had epidurals have gotten UTIs, but we nurses don't think of these things because we're not the ones who have to deal with it.
What else? She's been in the hospital for almost a week because of high blood pressure - they would've released her had she agreed to twice-weekly checkups, but she said she couldn't do that. She had a balloon filled with saline inserted in her cervix to dilate it. She was started on Pitocin this morning. She started with painful contractions that stayed painful even after the epidural, and the anesthesiologist was in there all day adjusting it. She received Fentanyl IV and epidurally and the baby's heart rate, which should speed up and slow down with contractions, went completely straight at about 135/min. The nurse showed me that and said the Fentanyl had sedated the baby. Anyway, she made some progress before I left. I hope she doesn't end up sectioned.
When her water broke they inserted an intra-uterine pressure monitor. Her contractions went up to 95 mmHg - normal contractions are around 40! Which is probably why they were so painful.
Oh, and she was caught having sex with her SO (husband, actually, I think) last night. The nurse PUT A STOP TO IT. Personally I wouldn't have said anything. Maybe they were trying to kickstart labor? Edit: Or maybe they were taking advantage of one of those fantastic birthing beds!
Originally posted February 10, 2009
Well, I suppose I shouldn't be surprised. I've caught fresh post partum moms engaging in intercourse with their SOs, but never a laboring mom. I have no moral opinion regarding any of this, but having given birth I would like to say OUCH! WTF? When I arrived for my 6 wk PP check up my OB GYN asked what I had been using for birth control. I reminded him he instructed me to abstain until further assessment at the 6 wk check up. Personally I fully expected another 6 weeks of abstinance.
ReplyDeleteI love your posts!
ReplyDeleteOh my goodness, that's funny. I couldn't imagine having sex in labor, but they say it helps.
ReplyDeleteFENTANYL!!?!?!?!?!? F me gently with a chainsaw. The crap is worse than heroin to come off (speaking from personal experience since a pain management doctor kept building up my dosages of the stuff over months and then took me cold turkey). WTF is that going to do to that baby?
ReplyDeleteOk, I know this is way after you posted this, so it's all over and done, but I'm shaking in indignation!
Allyson - I don't know if a one-time go of fentanyl is going to cause withdrawal symptoms. It typically doesn't in adults, I know, and while it is a baby we're talking about I'd worry more about depressing the heart rate and the drive to breathe. Which is what it did, at least for the heart rate.
ReplyDeleteWe know stuff like this happens because of our interventions (i.e. that epidurals cause fetal heart rates to drop), but we do it anyway because we think we have the tools to fix it (i.e. Pitocin, c-sections, NICU).
Everyone else - I can't believe I didn't comment to clarify this, but the event in question happened before the labor, while she was still sitting in the hospital for high blood pressure.
When I was waiting for hours to be discharged from hospital when I was in for a migraine consult, we debated having sex in the room to see if they'd just kick us out.
ReplyDeleteGettin' busy to try to make labor happen sounds like a good use of time when stuck in damn hospital for so long.