Posted by My OB said WHAT?!?.
Apr
5
Posted by My OB said WHAT?!?.
“…Don’t Come Back Unless You’re In So Much Pain You Can’t Talk…”
“Yeah, don’t come back unless you’re in so much pain you can’t talk, we prefer when you come in dilated to 8cm and your water has broken and you can’t get an epidural if you want one.” – L&D nurse to mother in early labor who was 4-5cm.
There are 55 comments to this post.
My cousin still got an epi at that stage… and I went from 7-9.5 in 20 minutes, and though I didn’t talk much because I had constant back labor and stayed in hypnosis, I still smiled and laughed and said something occasionally.
And again…. why not just stay home??? Being in the hospital is supposed to surround you with medical professionals to help you be safe right?
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Mamaspud had this to say,
Apr 5, 2012 @ 5:51 am (Quote)
Wait – isn’t today Thursday?? Actually, it sounds like this nurse is trying to PREVENT mama from having unneccessary interventions- epidural, Pitocin- and trying to encourage a natural birth.
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first time mommy Reply:
April 5th, 2012 at 7:05 am (Quote)
THANK YOU! I read that and I’m like WAIT….Today’s Thursday…isn’t it?! I seriously was wondering if I had somehow lost track of days this week.
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Nicole Reply:
April 5th, 2012 at 11:00 am (Quote)
I think it says something about the mindset of the women who frequent this board that it took 4 posts above you before anyone thought of this.
One woman could hear this and be comforted. Another would be offended. And that is the essence of everything that comes out of a provider’s mouth. I get so discouraged sometimes, because it seems like, to the women here, EVERYTHING a care provider says is wrong. Everything. I’ve even seen thoughtful thursdays be critiqued.
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first time mommy Reply:
April 5th, 2012 at 11:19 am (Quote)
True, but they normally label a post Thoughtful Thursday, so if this really is a TT, then I guess I’m surprised it’s not labeled.
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Tee Reply:
April 5th, 2012 at 11:30 am (Quote)
I completely agree that sometimes, health care providers are damned if they do, damned if they don’t on this site. I’ve pointed that out once or twice and people aren’t always polite when you point that out. In this case, I honestly didn’t read this one as being good or comforting. This site normally labels things as Thoughtful Thursday, so I don’t think this entry was meant for that. (Could totally be wrong there!) That’s part of the reasons I enjoy reading the comments so much, though. Oftentimes you get to see a totally different viewpoint and that’s always fun!
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Corita Reply:
April 5th, 2012 at 4:19 pm (Quote)
Well, I really don’t think she is being encouraging or kind, especially telling someone she “prefers” to essentially make it so that she can’t have an epidural. That is not right.
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Susan Peterson Reply:
April 6th, 2012 at 1:51 pm (Quote)
Why not? There is no right to an epidural. Whether she likes it or not, it will be better for the woman and probaby for her baby, if she doesn’t have one. Not only that, but she, or her insurance company, or Medicaid, ie the taxpayers, will pay a much smaller bill. I see a lot of advantages to this policy. However, I find it hard to believe that there is a hospital which operates this way these days. Most of them are vying for consumer dollars with their OB services. Also most L&D staff would rather have epiduralized women who need less attention and who don’t behave the way women behave who are having the raw experience of labor.
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Tee Reply:
April 6th, 2012 at 2:29 pm (Quote)
I don’t agree. If the hospital offers epidurals… and I’m sure they do… than the woman has the right to get one.
Look, I believe in and promote natural, unmedicated birth. (Home birth midwife before becoming disabled.) It would only be under extremely rare circumstances that I would ever encourage a woman to have an epidural. BUT it’s not my decision to make and it’s not this nurse’s decision to make. It’s the mother’s decision. It all comes down to informed consent and decision making. This nurse does NOT have the right to tell the woman she can’t have one if she wants one.
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Corita Reply:
April 6th, 2012 at 4:08 pm (Quote)
Tee, I agree with you.
An epidural is pain relief. Childbirth can be horrifyingly painful. Medical ethics dictate that pain relief be offered, when available, and unless the relief is contraindicated for medical reasons.
I don’t care if the hospitals DO like epidurals because they think women are easier to deal with (questionable reasoning, even if you accept the premise of the hospital wanting this)… OF COURSE human beings HAVE A RIGHT TO PAIN RELIEF if it exists, is affordable, and does not do more harm than good. If they want it.
That nurse was probably joking… I think it doubtful any hospital would have such a policy.
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Jen Reply:
April 6th, 2012 at 4:14 pm (Quote)
IF a hospital does not offer epidurals at all (and makes that policy known and does its best to prepare mothers-to-be for natural birth), that’s one thing.
IF a doctor determines that based on factors ABC an epidural poses increased risks of XYZ and therefore won’t order one on the grounds of “first do no harm” (and then supports the woman through the change in her birth plan) that’s one thing.
But many women have no other plan than to get an epidural. They’ve (wrongly) been told it has no risk and is a wonderful miracle blessing and why wouldn’t you get it? If an epidural is freely offered to all patients by the hospital, and it’s the mother’s only plan, forcing her to go through a natural birth she’s not prepared for will only cause trauma. Sure, she may avoid the consequences of the epidural, but she’ll be dealing with the consequences of her traumatic experience for long after.
And then there are patients like me, who DID plan for a natural birth and DID have coping techniques lined up. But when my birth headed south and the plan went out the window, I NEEDED that epidural. Yes, I truly believe that natural is best whenever possible. And I have no regrets about getting an epidural I truly believe was necessary.
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Toni Reply:
April 6th, 2012 at 6:47 pm (Quote)
Actually most hospitals view pain management as a “patient right”. At least if they are accredited by the joint commission:
http://www.jointcommission.org/assets/1/18/pain_management.pdf
So, with all due respect Susan, you are full of it. I fully support, and have had, unmedicated birth. But it should be a woman’s freely made decision. It should not be forced upon her when reasonably safe, effective means of managing her pain are available.
In conclusion, go piss up a rope hon
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jenni Reply:
April 7th, 2012 at 12:42 pm (Quote)
If a person gets a kidney stone do they not have the right to pain management?
A woman might have several umedicated labors but slight changes- baby’s size or position for example- or other underlying health problems, complications even, could make pain much less manageable on another occasion and they should also have the right to pain management.
many women take on pregnancy assuming they will want and need pain releif, which personally i think is not the mindset to start out in, but it would be inhumane to deny a patient that whether its because they elect to have it without much trial of pain tolerance, or whether they have managed the same thing before without medical pain relief and this time due to circumstances they do want/need pain relief.
i hope this makes as much sense written as it did in my head…
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Tee Reply:
April 7th, 2012 at 8:14 pm (Quote)
Does a person with a kidney stone have a right to pain management? Absolutely. Do they always get it? Nope, not at all. I have chronic kidney stones and have had many, many ER visits where they have refused to treat my pain, even with a documented stone.
What you said makes perfect sense, at least to me. It’s just as unfair to refuse someone an epidural as it is to push one on someone that has denied wanting one. It all boils down to informed consent and patient’s choice. The nurse (or whoever) has no business making that choice for a woman.
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jenni Reply:
April 7th, 2012 at 12:36 pm (Quote)
if i waited until i was in so much pain i couldnt talk, i’d never show up at the hospital, because for the few moments i do end up that uncomfortable, i sure as hell wouldnt be trying to get into a car, even for the .5 mile drive to my local hospital.
so….. unless a person is planning a homebirth, with midwife, or unassisted, then this might just be bad advice.
BTW my ability to talk is not greatly affected by my pain level, i’m a chatterbox and i seem to keep talking just fine ANYWAY.
please find another method by which to measure pain tolerance. even if its supplemental to this one and uses “or”
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Tee Reply:
April 7th, 2012 at 8:11 pm (Quote)
Girl, I’m the same way! I was actually in the ER tonight due to some post-op pain and complications. The nurse was trying to start an IV and at one point, he commented that I must be nervous. I was somewhat puzzled and told him that I wasn’t nervous at all. (I don’t mind needles.) “Well, the only time any of my patients chatter like this is when they are nervous!” Um, no. I chatter when I’m hurting. When I’m nervous, I tend to either freeze up or cry. Sorry, dude!
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Not everyone labors the same. At 9cm I was still walking the halls, chatting with my husband and doula. During another birth, I could barely think straight at 4cm, got to the hospital at 6, and was pushing 20 minutes later. This nurse sounds kind of like a sadist.
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Uhm…what kind of hospital does this nurse work at? Unless the patient tells us she’s been walking around dilated 4-5 centimeters for a while (which can happen, but not often), usually that’s a nice time to admit someone. Why would you want to attempt to admit someone when they can’t talk to you? At least at my hospital, there’s a couple key questions I need to ask (any allergies, baby moving okay, sign here for us to treat you, etc). Plus, it’s a scramble for us with our patients who walk in ready to birth (or really close at 8cm). We like to be able to at least put the patient in a private room and be set up to care for the baby if the baby doesn’t transition well.
And like Amanda said, not everyone labors the same. Some people loose their minds at 2-3cm, others stay completely in control throughout their entire labor. There are too many factors that play into how someone handles their labor aside from what they’re dilated. People with extremely rapidly progressing labors tend to not be able to talk as well as someone with a slower progressing labor.
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Toni Reply:
April 5th, 2012 at 7:58 am (Quote)
IDK. I showed up at 8 cm (not that I knew that until after I was checked by my MW, lol) and no one seemed to “scramble”. I waited until ctx had been less than 5 min for a few hours to leave my house and I was no longer able to walk/talk *during* ctx (which is what I sincerely hope this nurse meant… had I waited until I couldn’t talk *at all*, well, I never would have gone to the hopsital in the first place, lol).
I checked in, changed clothes, got hooked up to the monitor for a ‘test strip’, played 20 Q’s with my nurse, had blood drawn, and, by then my MW showed up, and checked me to find I was 8 cm. We agreed to rupture my membranes at that point, and it was still another couple of hours before my daughter was born. This was my second baby, she was pretty big (9lb, 2 oz), so pushing took awhile. I felt like I showed up at pretty much the perfect time; no one was worried about labor slowing down at that point, lol, and it was super encouraging to know I didn’t have much time left upon admission. I’m hoping to time things pretty much the same way this time.
The most disturbing part of this statement (to me), is the not being able to get an epidural if you want one part. Unless the mother was expressing an interest in birthing without meds (and even then, people are allowed to change their minds), that seemed out of line. Not to mention the fact that in many (most?) hospitals you can get an epidural pretty much anytime before you are complete. Had I asked for an epidural upon admission, I could have gotten one (tho, the reason I stayed home so long was because I wanted a low-intervention birth, and if you want to avoid interventions, it is best to avoid the hospital as long as possible). If the woman in question showed up 3 cm, wanting a natural birth, well, this comment may well have been justified (unless she was showing up early due to concerns that would make her higher risk).
Won’t know until we see the pink link.
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Toni Reply:
April 5th, 2012 at 8:01 am (Quote)
Okay, re-read it, she was 4-5 cm. That is still (IMO) kinda early to show up if you want to go unmedicated (I’d shoot more for 6-8 cm). It is the perfect time to show up if you are planning an epidural.
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Penny Reply:
April 5th, 2012 at 2:30 pm (Quote)
I was walking around dilated to 5 with my last child.. It’s not really that uncommon.
With my third child I went in to my midwife’s office and was at a 7-8, crossed the street to the hospital and I was dilated to 9, but didn’t have my daughter for another two hours. I plan on waiting at home for as long as possible with my next labor too.
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first time mommy had this to say,
Apr 5, 2012 @ 7:06 am (Quote)
MOBSW, isn’t today Thursday? Did things change and no longer doing Thoughtful Thursdays 
?
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I don’t like that she scares the woman by referring to a level of pain that’s totally unnecessary, but this is otherwise quite thoughtful. I’m glad someone at the hospital is trying to make sure women get out of there and save themselves from all that mess.
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41 week mommy had this to say,
Apr 5, 2012 @ 8:40 am (Quote)
I want to see the pink on this one. I would have appreciated a comment like this. If the woman had expressed a desire to birth without meds, it’s not all that out of line. The majority of women who spend their whole labor in the hospital will get an epidural, even if they don’t want one, and then end up regretting it. When you’re in that much pain, and it’s right there….
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I didn’t have an epidural until after I had already started to push and then only because my BP had skyrocketed and they were worried about me. Because of the way my DD was postioned my OB said that it would take a while for her to make her entrance. (almost 2 hours of pushing) I had transfered from the birth center because of my BP. However, even after the epidural they had me on both sides and standing (with support) to help reposition my lo. sorry for the spelling
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This was said to a friend of mine.
He doctor was out of town but the on call doctor was talking about induction because she was being induced in a week anyways and has a long history of problems during birth where she needs to watched closely.. She was also already in so much pain she couldn’t talk… She ended up lasting another 4 or 5 days after this, she ended up having the baby within 30mins of getting to the hospital because she didn’t want a rude nurse again.. She had consistent contractions for 2 weeks before having baby.
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abba12 Reply:
April 5th, 2012 at 1:52 pm (Quote)
…yikes :S There’s a lot of things wrong here.
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Susan Peterson Reply:
April 6th, 2012 at 1:56 pm (Quote)
It sounds to me as if the rude nurse saved her from having a C section. If she had been admitted they would never have waited that long, she would have had pitocin and an epidural for sure, and then if not enough progress in a few hours, bang, C section. Her body wanted to take its time to get there, but get there it did. The nurse may have been rude, but I think she did your friend a favor.
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Tee Reply:
April 6th, 2012 at 2:30 pm (Quote)
Susan, are you trying to justify this nurse’s behavior? There is no excuse to be rude! None!
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Corita Reply:
April 6th, 2012 at 4:12 pm (Quote)
Well, it is all well and good to look at it after the fact and say, “Well thanks to that nurse’s unprofessional behavior I avoided a c-section.” That is not a rational way to look at it. The woman could just as easily suffered major complications that could have been presenting as the pain she was having, or precipitous labor , say, from receiving improper care and from avoiding going to get care because she was afraid of being mistreated.
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Details Reply:
April 10th, 2012 at 10:01 am (Quote)
Susan I agree with you. Sometimes really horrible crappy things happen that have good side effects. Not that anybody needs to thank the nurse for being a bitch, but sometimes in retrospect we see these things and we just have to say thank God He put this horrible nurse there to stop something even worse from happening. It is probably just a coping skill. But frankly it happens all the time. Frequently those instances are noted as Thanks for being honest, I’ll be finding another doctor now.
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While I agree this is just plain mean, I wouldn’t personally mind this hospital as it seems they are anti unnecessary intervention
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Tee Reply:
April 6th, 2012 at 2:32 pm (Quote)
But how do we know that it’s the hospital that is anti-intervention and not just the nurse? Given the comment, I get the impression that the nurse is anti-intervention. If it was the hospital that was, the nurse wouldn’t have had any reason to even make this suggestion.
And no matter how you look at it, there is still no cause for this nurse to be rude.
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sara r had this to say,
Apr 5, 2012 @ 3:04 pm (Quote)
With both of mine I started pushing as soon as my water broke; that means 10 minutes and my second one was born …so apparently this nurse prefers car births? We stayed home for the second after the first one went so fast. I prefer my care provider to come to me!
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PetraStrider had this to say,
Apr 5, 2012 @ 6:19 pm (Quote)
Why would a nurse tell a mom that she can’t have an epidiral? I personally will be trying to go natural, but being told that I CAN’T have an epidural would make me panic and freeze up. (FWIW I did request an epidural last time and thought it was the most wonderful modern invention ever.)
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i showed up at hospital at 8cm, id only been in labour 3.5 hours where as some women take days to get to 5 cm, how the hell are we supposed to know, not everyone is able to feel their own cervix or even know what they would be looking for! i was never in that much pain that i couldnt talk, i preferred not to talk becasue it broke my concentration, but just before we left for hospital my contractions were double peaking worst pain id ever had all in my backfvcc cv Q and i was still able to talk to my toddler who was worried about me
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I got this same advice from the people who were trying to convince me not to have a homebirth. ‘Just wait until the baby is about to come out and then prance into the hospital.’ I thought about it, and it just wasn’t how I pictured my birth. Riding in a car during transition, the panicking and yelling, and the lack of support during all of the rest of the labor, all seemed unnecessary and stressful. I decided to ‘gamble’ on not needing a transfer with my homebirth rather than ‘gamble’ on getting an unplanned homebirth for a hospital birth. Everything went well. I think a lot of people also forget that with a homebirth, you are also paying for a very high level of prenatal care. I could not ever give a monetary value to the feeling of trust and safety I had with my midwife, as opposed to the uneasy feelings I have had with all of the OBs that I’ve experienced, not to mention my feelings about hospitals in general. It’s not just about homebirth. It’s about midwifery. I hope I never have to give birth somewhere I don’t feel safe enough to spend more than an hour.
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I think the “can’t get an epidural if you want one” part bugs me the most. I do believe that natural is better if at all possible, but if the mom thinks she needs it, she should be able to get it. Denying an epidural to someone who needs it is just as bad as pushing it on someone who doesn’t. It’s a medical professional deciding your birth must go their way regardless of your rights.
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icon downloads had this to say,
Oct 4, 2012 @ 2:33 pm (Quote)
Add Your Comment.
Wow, if every mother this nurse sees is in so much pain she can’t talk, then the nurse is doing something very wrong. I thought hospitals admitted labouring women at 4+ cm? 8cm is cutting it very fine if you’re planning a hospital birth!
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Sarah Reply:
April 11th, 2012 at 4:51 pm Sarah(Quote)
I don’t think I’ve ever seen 8. I’ve given birth 7 times and every single time I’ve gone from 4-pushing so quick that I wouldn’t have made it home, much less back, if they’d ever told me this!
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