#4 Epidural Shortage

Justine:

I want to say it was about a week ago that I received my first direct message on Instagram asking about epidural catheter shortages. And it was from a nurse in Canada. And I remember thinking like, oh my gosh, that’s awful. Like that sucks for them. And then I got, I think I woke up the next day and I had a couple more and mostly from Canada. And then I had a nurse just ask me a few days ago, “can you do a poll of who is short epidurals, you know, supplies or kits.” So I asked Canadian nurses, who’s short. And then she was ed, can you actually ask US nurses? And in my mind, I was thinking, we’re not short, you know, because I haven’t been seeing that on my own floor. And so then I did that and then a bunch of us nurses were saying, telling me they were short.

And then I went to work that night and we were short, and I was just like, this became a real life, me problem. And not just some problem that I’m hearing about. And then I started Googling it and you can read the headlines. So, I want to say that this episode is going to be about the epidural catheter shortage and the things we can do as nurses to help. But also, if you’re not having the shortage, we don’t want it to like to terrify you because maybe you won’t. You know? It’s not some doomsday thing. Maybe you’re not going to suffer from this or be impacted by this. And your patients will be fine if you’re a patient listening to this like this doesn’t mean that you’re not going to get an epidural at your hospital. I don’t want this to be a blanket cover-up for everybody. But if you are experiencing shortages of epidural supplies, this podcast episode is aimed to help you as a labor nurse because this can be really overwhelming. I’m overwhelmed. I’m anxious for our patients.

Sarah:

Well, and even if you aren’t experiencing an epidural shortage, it’s important for us to understand what’s happening in the world of obstetrics, and other places and be prepared with the tools to help our patients cope because who knows, you could have somebody that comes in with thrombocytopenia of pregnancy that they were unaware of and now they have to try and cope as well, which I’ve had to happen one other time. And so we want you to, as experts of birth, coping being one of them be an expert in helping your patient cope, helping them redirect. So, we’re going to give you some tips on coping and then there’s a fun little help coming.

Speaker 3:

So when you Google epidural shortage right now, it’s like global shortage has hospitals in Waterloo, conserving epidural supplies, shortage of epidural supplies, sparks concerns, shortage. I am seeing now it’s hitting Australia now for a shortage of epidural supplies. There are emails going out from to different units about how to decide who isn’t going to get an epidural. And so one hospital decided that low-risk multips are not candidates for epidurals at this time, which is really scary too. If you think of all these mot tips that probably got an epidural or maybe got an epidural on their first birth and they didn’t prep to not get one you know, because it went great in their last birth, right? So there’s, there’s a lot, there’s a lot in the news right now about this

Sarah:

It’s mostly in Canada, but we’re hearing behind the scenes before it’s hit the actual news that I texted a big hospital here in LA, whom I have contacts everywhere. But I was asking, talking to one of my friends and she’s like, oh yeah, it’s tubing first. It was tubing. We didn’t have epidural tubing. So we, you know, we adjusted and we got new pumps and now it’s the catheter. So they’re locked up in the back room. So, you know, whether it be epidural shortages or other supply shortages, we’ve been dealing with this since the beginning of the pandemic, whether it was PPE or something else. And I think, you know, prior to, prior to the pandemic, to be honest, I mean I worked at like a very bougie hospital here in LA and we had copious amounts of everything like “Oops, open the epidural kit and like, whoops, it’s not sterile anymore, let’s throw the whole thing away.” You know, which is what we should do. But I think as we’re anticipating this sort of new era of anticipating and living in the new era of shortage of supplies, I feel like personally I grew up overseas and I grew up in a third world country and I’ve traveled enough to understand that. Like I, I think it’s just important to recognize our privilege in the United States that like this is normal for a lot of places around the world and as much as, and as uncomfortable as it is for us. And it’s not ideal, it’s not what we’ve learned. It’s not, you know, like even using how many pairs of gloves per patient. So many sometimes, you know that that’s not the reality, a lot of places. And so the other places can flex and flow. We are going to have to be able to flex and flow with the times and deal with the disappointment and deal with how annoying and uncomfortable that is. But then also learn to be flexible given with what we got and make the use of what we got just like we did with PPE or even though not that not, we’re not getting into that because that was not ideal in many circumstances, but you know, it’s sort of like you have to do what you gotta do.

Speaker 3:

Okay. So what are our tips, Sarah?

Sarah:

Well, I wanted to just give you a little teaser for our coping with labor class. And you know, as we’ve been thinking about what do we, what do we do? How do we help with this sort of the overwhelm of the cultural state of these, these families that are walking into labor and delivery, expecting an epidural and being told that they don’t have access to that, is we need to be able to help them cope. And so we do have a coping with labor class on our site because of this cultural situation or, historical. Can I say that because I’ve never experienced this in my life. This is a historical moment in the birth world that we want to offer you a promo code for our coping, with labor class. You do get CE’s for it, it is super thorough.

It will talk you through all of this. We’re going to give you a teaser and give you some tips in this episode and that promo code for coping with labor is LEARN2COPEBBN for 50% off of our coping with labor class. So if you’re listening to this and you get to the end and you’re like, Ooh, love, need more. Help me out. I’m feeling overwhelmed, head on over to bundle birth nurses.com and you can watch that class on demand, and work through it at your own pace. So, in that class, one of the acronyms, came through mentorship and I made up an acronym and I remember you hated it initially. We, oh, I still, I still am like, this is hilarious. How is this a thing? But it’s become a thing if you’re in mentorship, you’ve heard us say BIPTAME and go through BIPTAME.

And I was trying to remember it. And I remember like initially, I was like bachelor in paradise takes after my ex. Yeah. I’m literally reading that line right here in the thing. I put it in the workbook. And I was like, I remember thinking that because I was like, how do you remember that word BIPTAME? Because I think BIP, I watch bachelor so, bachelor in paradise. So anyway, the idea is the, or the word is BIPTAME and this is a process for coping that I teach in this class that brings you through a sort of system. And coping is not a system. There is no perfect way to cope. Everybody is different. Every individual brings all of themselves into their labor. They bring their own history of what they’ve done to cope in the past that are tools for them to cope.

But if you are not knowing, knowing where to start this, if you go through BIPTAME with your clients, you’re going to bring them front and they can listen to you. And they’re actually like working with you versus like, ah, I don’t care. That’s a different story. You’re going to help them cope. So the first tip is breath. Breath is the foundation of coping. We have to help their breathing get under control. Breath is the foundation of coping. And so, you want to help them regulate their breathing, have some element of control of their breath. That’s going to help them cope the I in BIPTAME stands for instinct.

Once we have control of their breath, then we can tap into their instinct. We can say what feels good? What doesn’t feel good? What do you like about that? Not during a contraction because you don’t get through with anybody when they’re in pain through a contraction, but once it’s over, help them say that goodbye breath. Let it go. It’s over. It’s done with, thank you. Is what I end up saying with my patients like, okay, thank you for that contraction. Now we’re saying bye <laugh>. And so where bye, but what feels good? Because their instinct, their knowledge of their body, their awareness of their, of their, their sensations is going to help guide your recommendations to help them cope. If they’re have they’re saying I cannot stand, my legs are so sore. My butt is killing me. When I stand, what are we going to do?

We’re not going to stand.  So you have to actually ask them and help them. Not everybody is self-aware enough with their sensations in their body to be able to identify, oh, I actually have hip pain here. Cool. That will help guide you. In what recommendations you can help them make with their position, which is P. So B, breath, instinct and position. Position is so important. We know this, you have an OP baby, are they going to want to be flat on their back with the back of the head, pushing on their tailbone and all, all their ligaments and pelvic floor and all of that. No, they’re going to hate that. They’re going to naturally when they’re listening to their instinct, get on all fours, turn over. That’s actually going to help rotate the baby. Their instinct may be to move one leg versus two. Their instinct may be to squat down because they’re trying to get the baby into the pelvis.

Whether they know that or not, the positioning is going to help facilitate coping. One of the misconceptions I hear a lot with patients is that like, oh, but it feels worse. So I’m going to stay here because it should feel worse. That’s not actually a rule of thumb for labor. The goal is finding what feels better because that actually means we’re helping facilitate the baby’s rotation in the pelvis down and out all of that. And so, we want to help them identify their instinct to help them with positions. This is where our position guide comes in. If you don’t have one of our position guides, please head to bun with nurses and get one for yourself for your unit. We do fulfill purchase orders because that will help you identify and say, Hey, what if this sounds good? What instinctively looks appealing to you?

Justine:

I think too, it’s important to note that it’s hard for a lot of us to trust ourselves, especially in these cases. And so all of this too, it really depends on the rapport you’re building with your patient. Yes. And the trust you built with your patient to be able to help them believe in themselves, to help you figure out what their instincts are on positions and how they feel during these contractions. So it’s like multi-layered

Sarah:

To, yes, this is, this is complicated and definitely an art as a labor nurse, but it’s our responsibility as a labor nurse, partially the sort of the biggest challenge of labor. One of the biggest challenges of labor is coping well. And I think I like that too, because your awareness of the room and your perspective is a vantage point as a nurse that can also help them tap into their instinct. Hey, I noticed that you’re rubbing your back when you have a contraction, oh, let me grab your partner in for some touch because that touch, counter pressure, massage, heat, different sensation on their body not only helps with the sensation, but physiologically may realign the body. It may help soft tense tissues. Any tension in the body is only going to cause pain. Any fascia that hasn’t been loosened out or isn’t healthy fascia, we can, we can adjust for. And so that touch is literally whether it be gate control theory or not learn more at physiologic coping for that, because this is where we’re getting into all the path of a lot of this stuff. But that, that gate control theory actually removes some of that pain sensation and can decrease the number of pain for the patient. When you add a form of touch.

Justine:

One of my favorite things we offer actually is something that Sarah drew is our massage guide that we actually sell in the store and nurses will give it to families at the bedside to look through. And because sometimes it can be overwhelming to be like, where do I touch them? How do I touch them? You know? Yeah. And so it’s coming in Spanish as well, very soon, very excited about that. But this is a great tool to use at the bedside. And it is in the workbook for you to have if in this coping with labor class.

Sarah:

So we have our breath, then we’ve helped them tap into their instinct. We help them find a position and an instinctual position. We add a touch technique, whether that be something we do and then usually it’s, we’ll start it. And then I usually loop in the partner or the doula and show them what I’m doing for touch because we know you can’t sit there forever, like squeezing their hips, but their partner can. We couldn’t land on one or one or the other, so it’s aline and adjust. And the idea is we’ve gotten them controlled with their breath. They’re using their instinct to find that position. There’s some sort of touch technique. Now it’s perfecting it that at this point what’s left. And when you’re looking at them, are they totally crooked? And that might not be the pain of the sensation of the contractions.

But if they’re, if they’re crooked and their necks all kinked, that’s going to add one more discomfort to the circumstance. So let me throw a pillow in there. Let me support your belly here because they may not identify that their belly feels like it’s hanging because they’re focused on other sensations. So let me align your body. Let me make subtle adjustments so that you are fully supported so that you’re fully comfortable in this position with the touch or not. Some people don’t want touch, so that may not even be something you do. And then that moves into our mood. So once we’ve done all of this, it’s like now sort of as the nurse, you get to sort of step back and be like, okay, whew, we got ’em there. And then you get to look external. What can I do? Let me just lower the lights real quick.

If I haven’t already do we want some music on, do we need some chapstick? Do we have some water, and again, all these things create an environment of safety and security and calm, do we need to throw in some essential oils? How do we, how do we look big picture at the room? Does it look like coping land or does it look like full-blown chaos? Let me clean up a little bit in here. Let me like pull all the medical supplies. That’s where is there anything in this room that’s causing you? Any anxiety or discomfort, you know? And they’re like, yeah, I hate what is that? What is that over there? And you explain, oh, that’s the button in case we need somebody. We don’t, we rarely use it. Cool. We’re done with it. That’s all they may need. But it’s that sort of check-in with the mood and environment, leading us into your encouraging words.

If you don’t know what to say in labor, some easy words are going to be your prompting words. What do you want them to do and feel in their body? Peace, calm, relax, your shoulders, and drop everything down. Let go, surrender. You can say, does that feel good? Does that? And I’ll check in because some people surrender might be triggering or let go might be triggering. So, we want to use words that are appropriate for the patient’s circumstance. When I say relaxed, does that feel relaxing? Does that feel good? Or I’ve said a few words. Are there any that you really connected with and your words of encouragement, you’re doing amazing. Also, as a nurse, you get to offer a perspective that is, I’m going to say more possibly respected than maybe the partner. This happens all the time with me at the bedside.

The partner will be like, you’re doing so amazing. Yeah. This is totally normal. And they’re like, why do you know? Versus I literally come in and say the exact same thing, five seconds later. And they’re like, oh really? You just, you hit different as a nurse. Yeah. And so use your role, your authority, figure your scrubs in the room to stand into that place and use it to their advantage and to yours for that connection piece. I’m seeing this, you are doing incredible. I’ve seen this so many times look at this. I love the and find things that are real. I love how you’re, you’re adjusting your body based on the sensations. I love that you’re taking a rest in between. That’s so important. Those kind of words of encouragement. Not only build rapport, but they also encourage them forward to say, okay, I’m doing it right.

Because so often families think like I have to switch it up every time or like, am I doing it right? And this whole waiting game of like, okay, but like what next we’re literally just going through contraction after contraction. Don’t fix. What’s not broken. That if it’s working, then you don’t have to offer anything else. Let ’em cope until things intensify again. And then you might actually need to go through B team over again. As labor intensifies, let’s use a different breathing technique. Let’s shift our touch. Let’s try a different position. What’s your instinct telling you now I have to stand up. Oh my God, I have to stand up. Let’s stand up. Those kinds of things that as you kind of cycle through, what can I do? Do you need some water? Let’s pull your hair back. Let’s add some of those essential oils or let’s get in the bath for a new sensation and mood. Right? All of those. If you work your way through, you’re going to help carry them to the finish line.

Justine:

I’m glad you said something about the bath because I hear a lot from nurses that they have the bath, they have the showers, but they’ve never used them them. Oh. And so this might be the time to push, to use them. Yeah. And maybe, you know, it could be a shower on the birth ball. It could be sitting in the bathtub just for long periods of time. I would just work with your team and work with management, because this is the time to get creative. Speaking of creativity, there’s going to  be, I’m going to  share on the show notes, a triage form that a hospital created in Canada a few days ago on who to triage, that gets an epidural. I mean, and they give a bunch of tools too on like what they need to use. They luckily have like options like nitrous and different IV medications. And maybe that’s a thing. Maybe you’re a hospital that only uses one IV med. Maybe you need to look into other ones. It’s just like bringing ideas to the table to management. Because if you’re overwhelmed with the idea of it, I’m sure management is too. And you’re on the floor. Laboring. These patients, your insight is really valuable. And I think this could be a really unique opportunity to enhance and learn how to help your patients cope. And it’s, it could be really exciting.

Sarah:

Well, and it’s an opportunity too, that like desperate times call for desperate measures that now that an epidural let’s say isn’t available for all things. Maybe you’ve been trying to get nitrous on your floor for years and years and years. And now there’s like an actual reason, like, look, we need more options. Let’s expedite this. Right. It’s the same as like the vaccine, like we didn’t need a COVID vaccine. And then all of a sudden we had a vaccine like as in record time compared to other ones, right. That like those desperate times call for desperate measures. And so whether that could be as simple as the bath, we don’t labor people in the bath. Well, why? Because some people do so. And maybe it’s just a discomfort. Maybe it’s a policy thing. How do we shift the policy to be able to offer all the things, get really good at helping our patients cope and setting them up to not have those traumatic birth memories.

Justine:

And this might be maybe being a little more patient with your laboring patients on not starting Pitocin just to augment them to progress them a little further because then maybe you can do intermittent oscultation because they’re not on Pitocin and they can be in the bath for long periods of time. So just start thinking and talking to your colleagues and team and providers, because there are things that we can do because labor works and we know birth works and people cope around the world all the time without epidurals. Yeah. And so I think one of the challenging things is going to  be patients that expect it and because it is the norm, you know, and it is, they wanted an epidural and that’s great that they wanted that. And so that’s what I fear the most. Yeah. And so how are we protecting their psyche? The idea of not being, maybe not giving an opportunity to have an epidural

Sarah:

This brings me back to our trauma-informed classes as well, because whether or not you have an epidural or whether or not they have to endure the pain when they have the expectation of an epidural or not, that that does not mean that their birth has to be traumatic for them. It’s what their brain receives through the process. And so we have, we have multiple classes, but I’m going to recommend our trauma level one. And then if you like it, trauma level two that’s led by Krista Dancy she’s our trauma therapist. She’s incredible. And it sort of is giving you so many practical tools that when there are set expectations a certain way and they’re unfulfilled for the patient, how do we set them up to not walk away, traumatized from their experience? So that’s another, another resource that we have there for you.

Justine:

If your hospital is facing this shortage of epidural supplies or you’re worried it’s going to come, we encourage you to really step into this coping land and start becoming comfortable with helping your patients cope with labor. I do think it’s an area of opportunity for all of labor nurses and just units in general, to train on this and just be trained on how to help our patients cope. I feel like that’s what we do, right? We’re labor and delivery nurses. And we’re not just epidural and delivery nurses. I hope that there are some good outcomes from this with just some super skilled nurses coming out of it. So remember that you can always use the acronym BIPTAME that Sarah created

Sarah:

Start with their breath, then ask them about their instinct, change their position, add a touch technique and pull in the partner, the doula to help you adjust and align their body so that they look more comfortable set the mood, and encourage them with your word choice.

Justine:

Remember that we’re offering that 50% off promo code for everyone listening to this podcast, that’ll run indefinitely until the shortage is up. So flex and flow on that. The promo code LEARN2COPEBBN Thanks for spending your time with us here on this episode of happy hour at bundle birth nurses. If you’ve liked what you heard, it helps us if you leave a raving review subscribe rate, or share this episode with a friend, if you want more from us, head to bundlebirthnurses.com or follow us on Instagram. We’ll see you next time here on Happy Hour with Bundle Birth Nurses.