epi question

vababy · August 2012

I was told by my SIL that the hospital staff will not give you an epi unless you are further along in your labor. (or if you are too far along)

she also said that if you ask for one, the hospital staff will try to figure out how much pain you are in before they give it to you (another words, they won't just give it to you if you ask)

I keep reading these birth stories where epi's are offered freely and i was wondering if anyone had any experience with this. my goal is to stay at home as long as possible, so that when i get to the hospital it will be too late to offer me an epi.

thoughts?

tokenhoser · August 2012

This is going to be really hospital specific.

Often, they want you to be 3-5 cm when you get the epidural. And if they think you're about to start pushing, they won't want to bother as you'll likely have the baby before they can set up the epidural and it's not as effective for pushing pain as contraction pain anyway.

Nechie122 · August 2012

There's some controversial evidence that an epidural can slow down labor; I say controversial because there have been conflicting studies. For that reason, hospitals like to make sure you're in active labor first; though chances are if you're far enough along to be admitted, you're far enough along to get an epidural.

I'm not sure about your SIL's second point; I've actually heard the opposite: once you're in confirmed active labor, some doctors say the sooner, the better because at a busy medical center, it can take an hour just to get an anesthesthiologist to your room after you request one, nevermind that they have to give you an entire bag of IV fluids before it's administered.

You can also be "too late" for an epidural, but I'll tell you that when I arrived fully dilated with an urge to push my doctor told it wasn't too late to get one; but I think she might have been lying because I was in "I can't do this anymore!" mode. She said, "It's not too late but I thought going natural was what you wanted," which for whatever reason gave me the confidence to get through pushing.

sschwege · August 2012

As pp said it varies, but most hospitals would want you to at least 3cm. As far as it being too late, I know a woman who arrived at the hospital fully dilated and never had any intention of going med-free. She wanted an epi and they tried twice to give her one, but were unsuccessful. The doctor finally encouraged her to go without since she was so close to being done and was basically dragging it out by these failed attempts at an epi. She agreed and had both twins out quickly after. So for some hospitals I guess it's never too late!

As far as trying to figure out how much pain you are in, I'm not sure, again it probably just depends. I know when my SIL was in labor with her second she told the doctor she wanted to wait as long as possible to get an epi. When the doctor checked her she was at 4cm and she said she was still handling it well and wanted to continue. The doctor then warned her that her bag was bulging and once it went things were going to really pick up. So he suggested she get one right away, which is what she did. I guess there's a case where at that hospital all you had to do was get to 3cm and it didn't matter how much/little pain you were in.

RMama2012 · August 2012

It's hospital specific. My SILs hospital made her wait until 4cm but at mine, there was a lady who had it at 2cm. The nurse offered my the EPi around 9cm and said "some people think its too late but it's not."

mystrana · August 2012

Yup. I can confirm (not through personal experience but through friends and family), that it depends on the hospital's policy, which can vary.

bdutton0005 · August 2012

Alot of times it has to do with contractions and not cm as far as getting it. They want your contractions to be regular and not jumping in how far apart they are. Also as far as too late its going to depend on how fast you have progressed but once it is time to start pushing its to late. Even if they ordered it 2 hours ago if its time to start puch as in baby is crowning or you feel the urge then they will say its to late.

As far as trying to figure out how much pain your in most nurses know that is subjective, as in it is what the patient says it is. Although that being said you will get some old school ones that will tell yo uto suck it up your not in that much pain, not saying its right but some will.

BakerMommy · August 2012

As far as determining your pain level, she could be referring to the pain scale many if not all hospitals use. At my hospital, the nurses were required to ask me to rate my pain on a scale of 110 every so often. As PP mentioned, it's totally subjective, of course. I asked them to ask me about intensity rather than pain.

lindsay.lou · August 2012

My hospital strongly recommends waiting until 3 cm, but if you insist they will give it to you before then. Once I reached 4 cm, my L&D nurse said to me, "At this point, just let me know if or when you'd like an epidural and I'll call for the anesthesiologist."

Also, I got my epi at 10 cm, but different hospitals have different policies.

There is research showing that epidurals can slow or stall labor if they're administered before the active labor stage, which usually starts around 3-4 cm. For that reason, my birth plan with DS1 was to make it well into the active labor stage before getting an epi. It's probably my plan this time, too. I lurk and post on here just to get pain management ideas for making it to 8-9 cm without the epi.

ETA: The struggle I had during my L&D was that I knew I wanted the epi at SOME point, but I wanted to wait as long as possible. At the same time, I didn't want constant internal cervical checks, so the whole time I was wanting to ask for the epidural because I felt ready for it, but not wanting to ask b/c I wasn't sure how far along I was.

tokenhoser · August 2012

lindsay.lou:
The struggle I had during my L&D was that I knew I wanted the epi at SOME point, but I wanted to wait as long as possible. At the same time, I didn't want constant internal cervical checks, so the whole time I was wanting to ask for the epidural because I felt ready for it, but not wanting to ask b/c I wasn't sure how far along I was.

You should do some looking at the "emotional signposts" that doulas use to know how far along you are. They were totally accurate for me.

vababy · August 2012

thank you everyone for your responses!

lindsay.lou · August 2012

tokenhoser:
lindsay.lou:
The struggle I had during my L&D was that I knew I wanted the epi at SOME point, but I wanted to wait as long as possible. At the same time, I didn't want constant internal cervical checks, so the whole time I was wanting to ask for the epidural because I felt ready for it, but not wanting to ask b/c I wasn't sure how far along I was.
You should do some looking at the "emotional signposts" that doulas use to know how far along you are. They were totally accurate for me.

Thanks for the tip, I'm definitely going to look into that! Geeked

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