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Subject:
From:
"Elaine Lukasavitz, CNM" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 18 Apr 1996 11:46:53 -0400
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I am a Certified Nurse-Midwife in practice in a community hospital.  My
clients have all heard of epidurals and come in with requests for no pain.
 The anesthesiologists at the hospital prefer to do intrathecals because they
do not have to stay in house after they are given.  Our procedure for using
them is just like that for an epidural, so still and IV, monitoring, frequent
vital signs, etc. so no advantage there.  I think the list readers might need
to know that while the medication is given like a spinal, the medicines used
are small doses of those used for epidural, so women can move, walk, and in
our hospital use the jacuzzi after getting an intrathecal.  It does delay
labor progress, may have all the itching and nausea side effects that occur
with epidural morphine, and requires IV afterwards for management of the side
effects.  I can't say much about effect on the breastfed infant as most of
our clients (despite fervent effort) choose to bottle feed.
I do notice that many women who are "out of control" with pain progress
immediately to complete when forced by the anesthesiologist to sit up curled
and hold still while the intrathecal is given.  This happens so frequently
that the nurses routinely "set up" the room while the call is made to
anesthesia.
You also made a very interesting comment about community beliefs.  I find
that what a women's friends, family, and *everyone knows*  says about birth
and babies is much stronger than what I can tell her.  I find that working in
a community where the prevailing message is bottle feeding is taking all of
my patience and tact to begin to change.
Elaine Lukasavitz CNM

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