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- 1 回复 Mir
- Keep cool, especially for one like you who is "doing life and death business everyday". You immediately remind me of my favorite show, ER, and Geroge Kluni. I for no reasons, "definitely" believe you are him.
Again, I feel helpless to talk to you about medicine, such as preps, IVs, monitors, pills, labs, and many others I saw in the TV show, other than pure admiration for George, and his fellows. Therefore, I actually do not have one, as far as "medical points" concerns. I will leave "medical points" to you, doctor. Would this be a better "attitude", or at least acceptable attitude to you? I also have no problem to catagrized you as "most respective people" or the epidural "definitely the first choice". If you can offer me some other English words going beyond "most" or "definitely", I have no problem to use either.
oops, did I contaminate this forum again. I forgot to comment on the "red envelop" part. It takes me a while to collect my wits. Please allow me to let it go.
Keep cool, doctor. (Definitely, no shaky hand when you are holding your epidural catheter.)
- 1 回复 mgoo
- You are good here; it is not you contaminating the forum. Any medical questions, please feel free to ask, I am here to answer it, to the best of my medical knowledge.
Advantages of Epidural Analgesia
Provides superior pain relief during first and second stages of labor
Facilitates patient cooperation during labor and delivery
Provides anesthesia for episiotomy or forceps delivery
Allows extension of anesthesia for cesarean delivery
Avoids opioid-induced maternal & neonatal respiratory depression
Contraindications to Epidural Analgesia
Patient refusal
Active maternal hemorrhage
Maternal septicemia or untreated febrile illness
Infection at or near needle insertion site
Maternal coagulopathy (inherited or acquired)
- 1 回复 luguo
- mgoo: You are good here; it is not you contaminating the forum. Any medical questions, please feel free to ask, I am here to answer it, to the best of myDr. mgoo, thank you very much for the information!
- 1 回复 luguo
- 一般来说,孕妇在孕期保健时, 她的妇产科医生就会和她讨论并制订分娩的方式和计划,在这时会向她介绍动产和分娩的止痛措施和选择. 这时候,妇产科医生会把美国麻醉学会编写的简介交给孕妇,并帮助她选择哪种方法. 医生有义务向孕妇讲解所有的选择的利与弊，孕妇有完全的权力选择是否用，和用哪种方法。下面是美国麻醉学会编写的简介:
http://www.asahq.org/patientEducation/labordelivery.pdf
Developed in conjunction with
Planning Your
Childbirth:
Pain Relief During
Labor and Delivery
520 N. Northwest Highway
Park Ridge, IL 60068-2573
(847) 825-5586
mail@asahq.org
www.asahq.org
EACH WOMAN’S LABOR IS UNIQUE …
The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby and the strength of contractions.
Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options.
TYPES OF PAIN RELIEF
here are two types of pain-relieving drugs— analgesics and anesthetics. Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.
Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. In most cases, analgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery. Not all hospitals are able to offer all types of pain relief medications. However, at most hospitals, an anesthesiologist
will work with your health care team to pick the best method for you.
Systemic Analgesics
…… ……
Local Anesthesia
…… ……
Regional Analgesia
Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks and combined spinal–epidural blocks are all types of regional analgesia that are used to decrease labor pain.
Epidural Analgesia —
Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your
body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not nalgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum traction. Your doctors will work with you to determine the proper time to give the epidural. An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. You can move when it’s done, but you may not be allowed to walk around. Before the block is performed, your skin will be cleaned and local anesthesia will be used to numb an area of your lower back. After the epidural needle is placed, a small tube (catheter) is usually inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor. The medication also can be given continuously without another injection. Low doses are used because they are less likely to cause side effects for you and the baby. In some cases, the catheter may touch a nerve. This may cause a brief tingling sensation down one leg.
Because the medication needs to be absorbed into several nerves, it may take a short while for it to take effect. Pain relief will begin within 10–20 minutes after the medication has been injected. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel your doctor’s exams as labor progresses. Your anesthesiologist will adjust the degree of numbness for your comfort and to assist labor and delivery. You might notice a bit of temporary numbness, heaviness or weakness in your legs.
Although rare, complications or side effects, such as decreased blood pressure or headaches, can occur. To
help prevent a decrease in blood pressure, fluids will be given through a vein by a tube in the arm. This may
increase the risk of shivering. However, a woman may shiver during labor and delivery even if an epidural is
not given. Keeping a woman warm often helps to stop the shivering. Some women (less than 1 out of 100) may get a headache after the procedure. A woman can help decrease the risk of a headache by holding as still as
possible while the needle is placed. If a headache does occur, it often subsides within a few days. If the headache does not stop or if it becomes severe, a simple treatment may be needed to help the headache go away.
The veins located in the epidural space become swollen during pregnancy. Because of this, there is a risk that
the anesthetic medication could be injected into one of them. If this occurs, you may notice dizziness, rapid
heartbeat, a funny taste or numbness around the mouth when the epidural is placed. If this happens, let
your doctor know right away.
Spinal Block
…… ……
Combined Spinal–Epidural Block
…… ……
General Anesthesia
…… ……
FINALLY ...
Many women worry that receiving pain relief during labor will somehow make the experience less “natural.” The fact is, no two labors are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options. In some cases, he or she may arrange for you to meet with an anesthesiologist before your labor and delivery. Be prepared to be flexible. Don’t be afraid to ask for pain relief if you need it.
- 1 回复 luguo
- Mir: As far as whether epidural should be done or should not be done, I do not think we are able to figure that out, especially we are not experts but yMir, thank you for your comments! Please allow me to reply your comments tomorrow when I have time.
- 1 回复 mgoo
- luguo: Dr. mgoo, thank you very much for the information!You are welcome, and thanks for holding this epidural discussion Dr. luguo, at least we clean up this forum now.
- 1 回复 freeangelLin
- epidural不知道是什么意思，是不是无痛分娩（麻醉）的意思？
如果是的话，我倒想说2句：支持谐和，尽量不做。
我在日本生孩子的时候，日本的医生坚决建议不要使用无痛分娩，还特别开了一堂课来详细解释(内容忘了，只记得结论了)。
日本也不支持剖腹产，除非是难产，不像国内，动不动就推荐剖腹产，感觉很随便，很不负责任。
当然万事万物都不能一概而论、都是有个例的。但生孩子本来就是一个自然繁衍的过程，感觉实在不需要加入一些人工手段。
- 1 回复 mgoo
- Epidural是硬膜外止痛or无痛分娩（麻醉）的意思
Different cultures, different classes have different labor pain tolerance, some rich area people they have zero pain tolerance, even they have epidural already.
If you can handle the labor pain, you don’t have to get epidural.
Cesarean Section Indications, Primary
Failed trial of labor, non-reassuring fetal status, or other obstetric indication.
1. Dystocia, protraction disorder or arrest disorder, with adequate contractions
2. Fetal malposition (e.g., breech, brow, transverse lie)
3. Multiple intrauterine pregnancy (i.e., Twins, Triplets, Quads)
4. Non-reassuring fetal status, fetal distress (e.g., fetal acidosis)
5. Cord prolapse, placenta previa, or placenta abruption
6. Previous myomectomy or uterine reconstruction, which is full thickness or enters uterine cavity
7. Previous intra-uterine fetal surgery
8. HIV, active herpes
9. Medical or Obstetrical complications precluding vaginal delivery
10. Suspected macrosomia by sonographic estimated fetal weight greater than 4250 grams in diabetic individuals
- 1 回复 luguo
- 郭凯敏: 俺家两儿子也是用了此法出生的. 没发现异常现象. 好象比我聪明点. 倒是他们的妈妈老在怀疑是不是epidural 影响她的记忆力. 不知道有没有任何根据.郭凯敏看上去有点慢，人们都知道那是大智若愚，你的太太一定也错不了。
- 1 回复 luguo
- Mir: As far as whether epidural should be done or should not be done, I do not think we are able to figure that out, especially we are not experts but yYes, we follow indications here, or say guideline. You said: "medicine is not science." I partially agree, but I'd like to say, medication is partially science plus partially art, it's not as clear as 1+1=2, but there are still some regulations there. Everyone has unique reaction to medications and procedures, everyone has his/her own thinkigs, so that there is no one-fit-all here. A doctor has to treat different patient individually. Most important thing is to respect patient's choice.
Talking about "red bag", I haven't seen or heard any doctor here receive it. Sometime, a patient may send you a thank-you card, that's the best reward you will feel. generally speaking, you may receive some small gift from patient less than $20 if the patient insists on doing so. In this situation, most doctors will share the gift will the colleagues or leave it for the department. A doctor has no reason to keep a gift with the risk of losing his/her license. Now that no doctor accepts a "red bag", no patients know a "red bag" either. Where is "red bag", then?
When I went back to China two years ago, I visited my medical school. My mentor asked me seriously :"Tell me the real truth, dose a doctor in USA really not accept a "red bag"?" I told him as above and he was still not sure, which reflects the fact that how popular a "red bag" is in China.
- 1 回复 Mir
- luguo: Yes, we follow indications here, or say guideline. You said: "medicine is not science." I partially agree, but I'd like to say, medicaincWell said.
It is the humbleness which makes us strong. It is the understanding of our limitation which makes us go far.
- 1 回复 mgoo
- My friend gave 50” LCD TV (over 20000 RMB two years ago) and big money red envelops to the surgeon, who was so-called “laoxiang 主任”, other doctors and related persons before her mom’s open heart surgery, still mom died on the operating table because of uncontrolled bleeding. Very sad, the healthcare system is so corrupted. Doctors are making big money there.
I hope one day the Chinese people go to see their doctors without paying extra red envelop money.
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