March 28, 2024

Epidurals now available at GRMC

Image 1 of 2

Epidurals are now available at Greater Regional Medical Center (GRMC), allowing more pain maintenance options for local women giving birth.

GRMC is the only hospital in the area that provides obstetric care, since hospitals like CHI Health Mercy in Corning and Adair County Health System in Greenfield no longer offer the service. Other small-town hospitals with obstetric services include Red Oak and Atlantic, as well as Maryville, Missouri.

“While a lot of small hospitals have gotten out of doing obstetrics, we’ve got some awareness that many people in the community just assume for the obstetrical care that they have to go to Des Moines or Omaha, when we offer great, quality, personalized care in a much more convenient area,” said Dr. Kristin Bolinger, DO.

Testimonial

Cody and Valerie Morrison of Creston went to GRMC for both of their children, Rylynn, 14 months, and Brantley, 8 days. Valerie was not able to have pain medication during Rylynn’s birth, but she opted for the epidural for Brantley’s.

“It’s very painful,” Valerie said of her first delivery. “Labor was only six hours long from start to finish. She (Rylynn) just decided to come and come now. He (Brantley), on the other hand, was super slow. I think we were in the hospital like 15 hours before he was even born.”

Originally, Valerie planned on having an intrathecal procedure, which is similar to an epidural but only last about 2-4 hours. But, because of the rapid arrival of Rylynn, there was no time to do the shot, and both Valerie and her firstborn were also at risk for medical issues.

“Because the pain was very intense, when you push it relieves that pain, so that’s what you wanted to do. As a results of that, because she was born so fast, I ended up getting a third-degree tear,” Valerie said.

All babies are covered in mucus when they are born. Rylynn was not able to spew the mucus properly because of the rapidity of her birth, which caused her to stop breathing that night and hospital staff to pump her stomach of the mucus.

“With him, I didn’t have that (pain). I only had a couple stitches,” Valerie said. “It was more of a controlled birth and it let him come more slowly.”

The slower birth also meant Brantley coughed up the mucus fairly quickly, preventing further issues with his respiratory system.

“And, I didn’t have to see her lay there screaming, trying to get through it,” Cody said.

Valerie said the pain during the epidural procedure wasn’t even close to the previous birthing pain she had gone through, but once the medication kicked in, she couldn’t feel her legs and the process felt “uneventful.”

“I’m not a big pain person,” Valerie said. “I guess because it allowed for a smoother, less traumatic birthing experience than with her, it was all-around a very uneventful, laid-back kind of thing.”

Epidurals

Epidurals are nothing new to the certified registered nurse anesthetists (CRNA) at Greater Regional. Brian Gutmann, CRNA, said he and his coworkers do an average of 220 epidural steroid injections (ESIs) for chronic pain each year, a number that has increased dramatically in the past few years.

With labor epidurals available now, the only difference between ESIs and labor epidurals are women in labor will have a catheter stay in their spine to give continuous medication, rather than only getting one shot.

A labor epidural is a pain management option for women who are in the throes of labor. A catheter is put in the spine in the epidural space outside the dura mater, a membrane to help protect the spinal cord. The catheter stays there and allows a continuous flow of pain medication to the birthing mother.

Labor epidurals were not offered in the past because of the amount of manpower it takes to create a safe environment for the birthing mother. However, anesthetists and obstetrical and gynecological staff have increased at Greater Regional.

Comparisons

One non-medicinal option is breathing technique, while two medicinal options are intravenous (IV) medications, which go into the bloodstream, and intrathecal services, which is similar to a labor epidural, but is pushed in past the dura mater, where the medication bathes the nerve roots.

“It wouldn’t be the right choice for everybody,” Gutmann said. “But, we’ll have both options.”

The intrathecal procedure, however, only lasts about 2-4 hours. Currently, Greater Regional averages between 60 and 70 intrathecal procedures a year, and Gutmann expects that number to increase when labor epidurals will be available because, instead of waiting until their pain is at its worst, women will opt for the intrathecal earlier in labor and then opt for a labor epidural after.

“The epidural is probably the Cadillac or gold standard of labor analgesia,” Gutmann said. “And, the intrathecal’s a real good Chevy.”

Labor epidural kits at Greater Regional include pumps, a catheter, tubing and a manual button for women to dose themselves.

“We want our local moms-to-be to know that this is an option. We’re listening to them,” said LouAnn Snodgrass, Greater Regional executive director. “It’s something that’s been voiced as a concern, and we’re addressing it.”

Other options

Another possible option Gutmann and Snodgrass mentioned is the use of nitrous oxide, or laughing gas. Commonly used in Europe, nitrous oxide is becoming popular in the United States. There is no needle involved, it’s fast acting and the mother can give herself a dose if needed.

No matter which option a mother chooses, the most common safety concern at Greater Regional is the use of pain medication that will affect the baby.

“That’s one of the reasons epidural analgesia is better than IV analgesia in pregnancy, because that epidural medication does not cross the placenta and then make the baby sleepy,” Gutmann said.

When a mother has IV medications, the medications affect the baby because the baby is attached by the umbilical cord to the placenta, an organ that allows nutrients in, gas exchange and waste elimination via the mother’s blood supply.

However, neither an intrathecal nor labor epidural will affect the baby because they do not cross into the blood supply, and nitrous oxide also does not affect the baby because the mother and baby do not share an oxygen supply.

“Pain management for moms-to-be is individualized based on their risks and needs, as well as the baby’s risks and needs,” Snodgrass said.

Snodgrass and Gutmann both emphasized the choice for pain management is indidvidualized. A mother may not want any medication, while another mother may opt for both the intrathecal early in labor and an epidural when the intrathecal medication wears off.

“If you’re newly expecting or planning to become parents,” Snodgrass said, “check out Greater Regional for delivery of your baby because we’re going to have all options available.”