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Relief during childbirth within patients' reach Women can control anesthesia dosage at county hospital


Women looking to ease the pain of childbirth have a new weapon -- the power to self-medicate during labor and delivery.

No waiting for doctors or nurses. No agony. Just a simple gadget that provides an instant dose of anesthesia with the push of a button.

For the first time in the Baltimore area, such technology is in reach -- but only at Carroll County General Hospital, a small community hospital in Westminster.

"This was the first time I had an epidural that worked, that I could control all through the labor and delivery," said Betsy Berner, 35, who had her third child, Emily, in the county hospital's Family BirthPlace.

"The amazing thing about it was that it made it possible for me to witness the delivery," she said. "I had my wits about me enough to ask for the mirror and do all the things they tell you to do during Lamaze classes -- all the things I didn't get to do when my first two children were born."

The patient-controlled anesthetic, known as an epidural, is administered through a plastic catheter that is inserted into the woman's lower spine. The catheter is connected to a mechanical device that the woman controls.

When she begins to feel uncomfortable, she pushes a button to give herself a dose of anesthesia. If the button is pushed too often, the machine will stop delivering the anesthetic, a safeguard against overdose.

"It bathes the nerves that extend from the spinal canal to the body with an anesthetic, getting rid of the pain without interfering with the woman's motor strength," said Dr. Andrew M. Green, chief of anesthesia services at Carroll County General.

The result: contractions without pain.

"We find it makes the patient more relaxed and makes labor go smoother," he said. "It also frees up nursing time. They spend FTC less time filling out paperwork and preparing medication, and more time with the patient."

Patient-controlled pain relief has been used in hospitals for more than a decade, although it has only recently been adapted for use during childbirth.

"We've used intravenous patient-controlled medicine for quite a while to relieve pain, particularly after surgery, but the idea of doing that with an epidural is fairly new. People are still trying out different settings on the pump," said Dr. Joy Hawkins, director of obstetric anesthesia at the University of Colorado and former chair of the committee on obstetric anesthesia for the American Society of Anesthesiologists.

Hawkins said patient-controlled anesthesia during labor and delivery has been adopted by several teaching and community hospitals across the country in the past five years.

"It seems to be the small community hospitals where it's catching on because of nursing issues and staffing problems, and at teaching hospitals because that's where new technology is tested," she said.

The movement might have been sparked by a back-to-nature backlash. Five years ago, nearly half of the 4 million women who gave birth had an epidural during labor and delivery -- twice the number who had epidurals in the late 1980s, Hawkins said.

It took about eight months for anesthesiologists at Carroll County General to adapt the technology they had been using for years to treat patients undergoing joint replacement surgery. Protocol had to be established, new nursing flow sheets had to be created and the staff had to be trained, Green said.

The hospital has offered patient-controlled epidurals to women during childbirth for about nine months. Nearly 1,200 babies were born at the hospital last year, Green said, and the number is expected to climb as more women learn about it.

"I've recommended the Family BirthPlace to all of my friends who are of childbearing age," said Berner. "It was truly a blessing."

Pub Date: 12/04/98

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