Posted by My OB said WHAT?!?.
Jul
10
Posted by My OB said WHAT?!?.
“We Can Tell You Are Getting Pain Relief By The Look On Your Face.”
“We can tell you are getting pain relief by the look on your face.” -L&D Nurse to mother who stated her epidural was not working during her Cesarean.
There are 42 comments to this post.
Sarah Dorrance-Minch had this to say,
Jul 10, 2010 @ 5:18 am (Quote)
*ahem*
Oh, Nurse? (Obstetric surgeon and anaesthesiologist, you ought to be paying attention, too, this is important). That glazed look on her face? It’s not pain relief. It’s shock. She’s going into shock from pain. Yes, people do this.
Put her under. She’s requesting pain relief that actually works. Obviously the epidural has left a “window,” so it’s not working.
It’s not NICE to give people abdominal surgery without pain medication.
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See–compare this to yesterday’s “Oh shit, we’re going to have to knock her out!” and which would you prefer?
I wish there were some kind of screening device to pick up the people who go into medicine because they think they know more than everyone around them. Every morning they’d have to pass through an Ego Detection Device and when it picked up a high concentration of ego and condescension, it would flash red and an alarm would go “BWOOOOP! BWOOP!!!” and an armed SWAT team would pour into the lobby, remove the nurse or doctor who had set it off, and the individual would be escorted to his or her vehicle after having his or her ID tags removed, pending investigation and six weeks working as an orderly in a hospice setting where he or she could learn to listen to patients and get used to the idea that sometimes the doctor or nurse simply is not in control of everything and doesn’t know everything he or she thinks s/he knows.
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Sarah Dorrance-Minch Reply:
July 10th, 2010 at 5:36 am (Quote)
An OB or anaesthesiologist who says, “Oh, shit… Sorry, Sarah, we’re going to have to knock you out, the epidural doesn’t seem to be working.”
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Jane Reply:
July 10th, 2010 at 5:40 am (Quote)
In an emergency situation, I’d rather the doctor save the middle step and give the orders right to the people who have the power to carry them out rather than talk to me. I have no qualms about being discussed in the third person when someone is going to save me tremendous amounts of pain.
You know, things like, “FRED! Grab the jaws of life! We have to cut her out of this burning vehicle!” would be much preferable to “Jane, sweetie, the car is on fire, but you don’t need to worry even though the doors have been crushed and can’t be opened. We have this special tool call the jaws of life that we’ll use to cut open the top of the car, and–”
BTW, has anyone ever brought a lawsuit against a hospital for this kind of crap? “I told them I could feel everything and they said I couldn’t.” I would think someone could get a mega-mental-distress lawsuit out of this kind of trauma.
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Sarah Dorrance-Minch Reply:
July 10th, 2010 at 5:48 am (Quote)
Good point. My c-section wasn’t an emergency. There was plenty of time to test my abdomen with a scalpel to see if I felt pain, or just pressure. It was how I was able to tell the anaesthesiologist, “I’m not making this up. Yes, I know the difference, because my left side feels nothing but pressure. My right side burns when you cut me. It’s pain. My regional isn’t working properly.”
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Jane Reply:
July 10th, 2010 at 7:44 am (Quote)
What causes an epidural not to work, or to work only in certain areas?
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Dee Reply:
July 10th, 2010 at 11:57 am (Quote)
I think some of it has to do with the placement. I did not have an epidural with childbirth, but I did have one in my neck for treatment of herniated disks. This guy was board certified and very skilled, but on the first one (probably because of swelling), it hurt a lot at first, and he had to make some adjustment of where the catheter was placed–then it was fine. No problems on the subsequent ones (3 over one year). Friend who have had epidurals have told me that it really depends on the skill of the anesthesiologist and how carefully the epidural is placed. Another reason why I absolutely refused to consider one in childbirth (plus it hurt!)
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atyourcervix Reply:
July 11th, 2010 at 8:55 am (Quote)
When the epidural catheter is threaded into the epidural space, it can sometimes migrate or point off to one side or the other. I wish I could draw a picture of what the epidural space looks like to make this easier!
Like above, kinda. There are nerve roots that go off to each side, and if the catheter tip goes into one of them, or is off to one side more than the other, it will feed the one nerve root more than the other. The other side will have less medicine (or none at all) and will have spotty (or no) pain relief coverage. That creates either a “window” of pain, or total pain felt on that one side.
To fix it, the anesthesiologist can pull back slightly on the epidural catheter to get it more in the central space. But it does take some more time to get the medicine to bathe the nerve root that previously didn’t have medicine coverage.
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atyourcervix Reply:
July 11th, 2010 at 8:57 am (Quote)
OOPS! My picture didn’t show up. Let me try again.
== epid space ==
each == is a nerve root coming off of the epidural space.
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Sarah Dorrance-Minch Reply:
July 11th, 2010 at 1:04 pm (Quote)
Part of my problem might have been that I have scoliosis. Not bad enough to require a brace, and I’d probably be able to get it unbent with a combination of yoga and chiropractic adjustment, but currently my curve comes and goes to the point where my height has been measured as high as 5’9 1/2″ and as low as 5’8″ (I am naturally 5′ 10 1/2″, or I was in my early twenties, anyway.) The variance is probably partly due to inexact rulers, partly due to how much exercise and stretching I’ve been able to work in. Basically, if I don’t maintain myself well, the curve gets more pronounced.
The anaesthesiologist remarked on my curved spine when he inserted the epidural catheter. I guess the best place for the catheter was still less than ideal. Or something.
I still can’t help but wonder why my CNM’s senior partner would order an epidural drip for a migraine – my pain was all above my waist, I found the sensations of cervical stretching annoying but hardly unbearable at the time – but hey, it was one of many things about my first birth that really didn’t seem to make sense.
Having a pronounced curvature of the spine would affect things somewhat, I suppose.
I’ve also heard that when a mother has had an epidural in for a long time, the nurses try to rotate her on a regular basis to keep the medication from pooling on one side of her body, but I have no idea if it works that way or not. I REALLY need to reread my physiology textbook.
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atyourcervix Reply:
July 12th, 2010 at 9:22 am (Quote)
Yes Sarah, we keep rotating women with epidurals from side to side for multiple reasons. One is to make sure the medication doesn’t pool on one side and coverage stays even with the epidural. Another reason is to facilitate rotation of the baby during the labor process, so that the baby does not get “stuck” in one position from mom being on one side for hours. A third reason is for mom’s comfort level. I know that I hate lying on one side for very long, so I would guess that other women would feel the same way. Plus, would you want to have the same view for hours, facing one direction? So, there are multiple reasons to change positions while in labor with an epidural.
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Rachael Reply:
July 24th, 2010 at 10:29 pm (Quote)
wow. When I had my first baby (which was a disaster). My first epidural failed and he had to try twice more. I was so medicated I couldn’t move til the next day – anyway, they never tried to move me. I was in labor 17 hours too. Never knew you were supposed to be moved.
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Jennifer B. Reply:
July 10th, 2010 at 6:10 am (Quote)
I honestly don’t care whether the mom is a drug addict, if she claims she’s having pain DURING open abdominal surgery, GIVE THE WOMAN DRUGS! It’s not like the woman is going to go get pregnant so that 9 months later she can get a fix… come on! Besides, an epidural doesn’t alter your mental status, it alters your pain perception… it’s not a fix!
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cheeks023 Reply:
July 10th, 2010 at 6:23 am (Quote)
the fix comes after the C/S with the narcotics they give you for the pain.
Sorry, that really has nothing to do with the topic, but I have first hand experience with this from a very good friend of mine. She’s a recovering addict, and said getting an emergency C/S was SO not helpful to her, because of the pain meds after…she struggled really, REALLY hard to not fall back into old addiction habits with the narcs they gave her. She is desperate for a VBAC this time because of that very reason.
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Cmat Reply:
July 10th, 2010 at 7:05 am (Quote)
I hope your friend gets that VBAC and finds a doctor willing to help her. You would think that with someone fighting that hard that someone would want to. If not an OB, then a midwife.
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Sarah Dorrance-Minch Reply:
July 11th, 2010 at 1:11 pm (Quote)
Midwives are generally more supportive of VBACs, anyway. Also, unless the midwife in question is a CNM, she can’t prescribe medication in the first place.
This would probably be a better situation for a recovering opiate addict. It removes even the temptation.
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Sarah Dorrance-Minch Reply:
July 11th, 2010 at 1:08 pm (Quote)
Nobody wants to give you narcotics for ANYTHING where I live, even when you’re not a recovering opiate addict. Even when it’s obvious that the benefit of strong pain relief outweighs the risk of creating a dependency. Usually, if you are prescribed anything for severe pain, it’s hospital-strength ibuprofen, or another NSAID.
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Jennifer B. had this to say,
Jul 10, 2010 @ 6:00 am (Quote)
At my son’s birth by cesarean after 2 days in the hospital in labor trying for an unmedicated birth, I told the anesthetist that I could feel them cutting me… I was actually ok with it, because I thought it was the only way I could feel my son’s birth and it wasn’t PAINFUL, but I could feel sensation. He ramped up the dose and took away all sensation.
At my daughter’s birth, because of my notes in my medical history that it takes a lot of epidural to take away feeling, they wouldn’t even START till I told them I couldn’t feel anything… and then when I started feeling my toes twice during the surgery they ramped up the dose…
I am grateful that I didn’t have to deal with an unmedicated or UNDER medicated cesarean…
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I love care providers on a power trip. She already has the epidural in; is there something wrong with bumping it up a notch even if she “may” be exagerating what she feels? (Not suggesting a woman would ever do that, but just the same)
When your labouring with an epidural they are all about bumping it up, and bumping it up, and keeping you as numb as possible, so why is there a difference in surgery?
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Jane Reply:
July 10th, 2010 at 7:43 am (Quote)
Because in both cases it’s a power trip. *I* can control your labor by turning up the epidural. *I* can control your surgery by not turning it up. Etc.
BTW, has there ever in the universe been a case where a woman who is already numb with the epidural has begged for more epidural medication? And why would anyone do that?
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this one was mine. I was induced with pitocin and I told the nurses that i didn’t want an epidural and each time i said that the nurse replied ” In a little while you will screaming for one. I usually give new moms to about a 3.” The nurse must have asked me 3 more times if i wanted an epidural and each time i told her no. Later on that night the nurse walked in and said “Your epidural is here.” At that point i was so tired and exhausted and it was right there, i caved in and said ok.I was still a little miffed because they knew my feelings about the epidural and they did not respect my wishes at all. I didn’t really feel the epidural being put in but i remember thinking, i thought it would take the pain away more than this. I kept telling everyone that the epidural wasn’t working. I could still feel the contractions, which were coming right after another with no break in between because the Pitocin was now maxed out. The nurse kept telling me she could tell i was getting pain relief by the look on my face. I was getting mad because i knew what i was feeling and it was EVERYTHING. Another nurse said to me “honey imagine what it would be like without the epidural” At about midnight the doctor came in and told the baby was big and wasn’t moving and i could be in labor for days. After 18 hours maxed out on pitocin, i had only dilated to “maybe” a 3 and this wasn’t fast enough for him i guess. I asked him if it was his wife what he would do and he told me he would tell her to have a c section. As they were wheeling me to the operating room i told them i could feel the medication going down my spine and it was cold. They finally realized that the epidural hadn’t been working this whole time. They had told my husband Krystopher to go scrub up and they would come get him when i was ready. Since the epidural hadn’t worked they decided to do a spinal block. It seemed like it took forever for them to stick all those needles in my spine. When they were done the doctor asked if i could move my feet and legs, and I could. They had me lay down and poked me with toothpicks and asked which leg and if i could feel it. I could. The anesthesiologist was standing behind me and when he found out i wasn’t numb he said, “Shit, we are going to have to knock her out.” I looked at him and said “Shit what!?!? Why did you say shit?” The doc told one of the nurses to get the intubation cart and i busted out crying. I did not want a tube down my throat and i did not want to be knocked out and i was scared. They tied me down to the table as i sobbed and bawled, “I never thought it would be like this.” i kept saying over and over. No one had gone to tell my husband what was going on. Little did i know he was in a panic too. The doc told me to stop crying and just breath as he put the mask over my face. That was the last thing i remember before I was cut open. When i woke up i was in excruciating pain…..They couldn’t give me any pain medication until i woke up from the anesthesia.
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Kat Reply:
July 10th, 2010 at 8:23 am (Quote)
This just breaks my heart.
No one should be treated like that, and have such traumatizing memories of their child’s birth day. Especially when NONE of it was even close to necessary.
I am so sorry you were treated with such disrespect and callousness.
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cheeks023 Reply:
July 10th, 2010 at 11:38 am (Quote)
I’m so, so sorry that you went through that. What a terrible ordeal. I hope you are able to find some peace. {{HUGS}}
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Dee Reply:
July 10th, 2010 at 12:02 pm (Quote)
OMG, this sound like torture, pure and simple. What an awful story! I’m so sorry this happened. Another case where I’d pursue litigation. CLEARLY there were problems–from the stupid nurse to the lack of pain management post-partum. How are you doing now? When did the birth take place?
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Sarah Dorrance-Minch Reply:
July 11th, 2010 at 1:17 pm (Quote)
This is definitely grounds for lawsuit.
Also you can report the parties involved to the state medical licensing board, complain to the hospital ombudsman and demand that the administration discipline the doctors and staff who were involved (including termination of employment), and complain to Angie’s List and doctor-rating sites – I like Angie’s List because it doesn’t just specialize in medical complaints, it handles ALL consumer complaints, and unlike many of the complaint boards on the internet, Angie’s List is a consumer protection business that’s been around for years and they actually do follow-up on the complaints to make sure that they aren’t malicious gossip, and to help get the situation resolved.
What a horrible birth experience. From the medwife who got skittish and wanted you induced right down to the mishandled c-section. I am so sorry.
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Kate, Ren's Mom Reply:
July 10th, 2010 at 8:47 pm (Quote)
No one should have to go through what you went through. I am so sorry. (((hugs)))
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Rachael Reply:
July 24th, 2010 at 10:38 pm (Quote)
you poor woman. that has to be the worst birth story I have ever heard (and I still have nightmares about mine – it doesn’t compare). I hope you are your baby are doing well.
I’m not a sue-happy person, but I think you should in this case. If for no other reason than to see that this hospital doesn’t treat another mother this way.
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They could give you pain meds until you woke up from anesthesia? I’m sorry, I don’t believe that. I had general anesthesia with my c-section and I’m pretty sure I was hooked up with major drugs right after the surgery. I remember feeling pain, but I also remember feeling really drugged up.
OP, I’m so, so sorry they treated you that way. So, so sorry. No one should ever be treated that way. Ever. I wish hospital staff could be made to really understand how we (patients) feel.
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StaudtCJ Reply:
July 10th, 2010 at 11:24 am (Quote)
It’s possible that they couldn’t because she had trouble with the spinal and the epidural. I know that they had trouble with the spinal for my knee surgery, and knocked me out, and they also couldn’t provide any medication until I was conscious and could tell them how I was reacting. Something about combining medications and dosages and not knowing how much I’d actually metabolized of the previous medications and needing my conscious input?
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this took place 15 months ago. Yes that is what they told me, they wanted to make sure i WOKE up before they gave me more pain meds…who knows? my birth was very traumatic for me and if i have any more babies, i do not want a hospital birth
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Cmat Reply:
July 10th, 2010 at 2:10 pm (Quote)
Go with a midwife if you at all can. That’s what I’m trying to go for and mine wasn’t near what you went through. I made it to a 5 without pitocin then my labor was augmented with it.. the contractions I had pre-pitocin were small potatoes compared to the pitocin ones. I could have carried on a normal day if not for the leaking feeling from my water breaking. I’m hoping that I can avoid any absolutely unnecessary interventions next time around and you could probably do the same.
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Jane Reply:
July 10th, 2010 at 4:45 pm (Quote)
Second the midwife. Explain how badly the sadistic hospital staff traumatized you during your first birth and ask about the midwife’s intervention rates.
Labors are easier when they’re spontaneous and the mom feels safe and unharassed and able to move around on her own.
I’m sorry you were so badly mistreated by these folks.
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Sarah Dorrance-Minch Reply:
July 11th, 2010 at 1:24 pm (Quote)
After my unneCaesarean, I decided I was done with hospitals, too – although my second birth wound up a hospital VBAC anyway because a virus I’d caught from my husband and daughter triggered premature labour, and I didn’t know I was in labour, so when the paramedics showed up at my door I thought going with them would be a good idea because I was afraid all the vomiting and diarrhoea might trigger labour or otherwise hurt the baby… Note to self: Never homebirth with the windows open, if you’re a screamer. Even if you have no air conditioning. Because in birth, screaming into a pillow or gag will deprive the baby of oxygen and it just isn’t a good idea.
Anyway, my third birth was at home, and in a couple of weeks or so, my fourth birth will be at home, also. The midwife might even get here in time to catch the baby this time, although given the patterns of oxytocin release I’ve noticed during not just birthing but also breastfeeding, I’m not going to count on it. She gives good aftercare, though.
And she, like most midwives, is VERY supportive of VBAC – at home or anywhere else the mother feels comfortable.
Get a midwife.
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The Deranged Housewife had this to say,
Jul 10, 2010 @ 8:37 pm (Quote)
I don’t know what it is with them asking if you’re in pain and then not believing you. I went through this same crap with my first section, only it was with the PCA pump they give you. The nurse installed the line improperly and therefore the Demerol was running into my tissues, not into my veins. I know that horrible burning sensation you’re talking about like your guts are being ripped out – I remember getting up the first day after surgery with nothing but Lortab in my system when I should have had more pain relief. It was horrible, but your ordeal was much, much worse. I’m so sorry.
I hope you do have more babies and go on to have wonderful, peaceful births! 
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Yep, cuz Mom’s just gonna fake it while having major abdominal surgery!
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Jane Reply:
July 10th, 2010 at 5:36 am Jane(Quote)
Because as we all know, there’s a huge movement among pregnant women to be totally unconscious during delivery and have to recover from the effects of general anesthesia during the first few days of caring for a newborn. It’s the latest trend. :-b
You’d think that the violent screaming concurrent with cutting her body open might tip off a trained medical professional to the presence of PAIN. Geez.
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