Re: << The latest infraction was a mention in class that any meds including
epidurals have the potential to effect the initial nursing experience.
I have the documentation to back my claim....This situation was complicated
by the fact that the mom in question who told her MD about the info I gave
was a 46 year old 1st time mom expecting twins.....she came to class saying
she did not want an epidural, before we even discussed meds and her opionion
did not change after class, however it is this MD's standard practice to give
all moms epidurals when they are delivering twins "just in case". >>

You have research evidence. What evidence has the doc got? If he has good
evidence that epidurals are completely benign re: breastfeeding, then you
probably would want to say the data conflicts re: effect of epidurals on
initial breastfeeding. (Might want to mention that not all epidurals are
equal in terms of meds used, bolus vs. continuous, etc.) But I'd say any doc
who thinks he/she is supposed to be believed based on personal opinion vs.
research evidence is the one "being difficult"!

I'm unaware of any research evidence that rules out an unmedicated delivery
for a full-term, or close to term, twin pregnancy as long as the first twin
is vertex. I do think the mother should be made aware that if the 2nd twin is
not vertex there is a very good chance that the doc will have to go up and
get that 2nd twin. This is not comfortable! Most MOT would prefer being
anesthetized if that is a likely possibility. She could be given a light
general, but I don't think we could blame her for wanting an epi or saddle
block so she can be awake and aware.

Karen

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