Kathy,

I prefer an intrathecal over an epidural because moms can move around more.
 However, they use Duramorph (morphine) in our intrathecals at the military
hospital where I practice  as an L & D nurse.  I see the same BF problems
that I see in some of the babies born after a labor epidural-difficulty
latching, no rooting (they search but can't find) and they aren't alert.

An excellent reference was published in JOGNN about two years ago on
intrathecals.  It was written by a nurse down the interstate west of me in
Hays, KS, a small town in the part of Kansas people usually visualize when
they think of Kansas-flat wheat and corn fields for miles and miles.  She
practices at a hospital pretty similar to yours, I'm sure, as most of the
hospitals in Kansas are small and in rural areas.  Hope this helped!

When it comes to regional anesthesia for labor and birth (IMHO), I've found
fewer BF difficulties in the moms who receive an epidural dose of Fentanyl
and just a touch of Marcaine and no perineal dose for birth.  I've assisted
with over 2000 births to date over 9 years and overall, I've been happier
with intrathecals than epidurals because of the ability of the moms to
still feel pressure and push more effectively with the intrathecal.  They
usually itch like crazy from the Duramorph and a little Benadryl takes care
of it.  I'm sure the childbirth educator in you is thinking "Oh, more
interventions I see."

On that side note, I got a call from the patriarch of the OB practice in my
town today.  He was upset because one of the childbirth educators that
works with me told his patients that they have an increased risk of forceps
with an epidural and it scared them.  All three came in with birth plans.
I told him that her comment was based in valid research and that this is a
true statement at our hospital also.  After a calm discussion with him, we
agreed to disagree and he threatened to have all of the classes taken away
from the hospital and done by his practice only.  The power struggle
continues...

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources
Student Nurse Midwife
Manhattan, KS  USA

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----------
> From: Louis and Kathy Bolgrihn <[log in to unmask]>
> To:
> Subject: intrathecals
> Date: Tuesday, October 28, 1997 6:09 PM
>
> Dear Lactneters,
>
> I am interested in any information your would have on intrathecals. We
> are a small hospital that is trying to keep in line with the market. We
> have been fortunate to not have epidurals as an option, but now will
> soon introduce the intrathecal.
>
> I am especially interestd in the effects on the nursing baby. I help
> teach childbirth classes, and we have always been open to our mom's
> about the advantages of her being in control of what goes on with her in
> labor. We try to have mom's move around as much as they can and use
> other forms of pain control.
>
> What is the effect on the nursing baby? Are they a better option than
> the others out there?
>
> Thankyou for all your help.
>
> Kathy
>