This is something I am curious about.
I have taken lots of pain meds in my time. I have had 7 teeth pulled, 3 root canals and countless other dental issues, requiring some form of narcotic pain relief either before or after, not to mention pain meds for afterbirth pains. In addition, I get migraines and take meds for that, after having tried out several different options.
And in reading up on all the stuff I have taken (got any questions about vicoden, hydrocodone or vicoprophen?:-) ) something that is discussed quite a bit is that it's best to take the pain meds before the pain gets severe. That pain meds work best on the pain the earlier you take them.
Is this something that's true for epiduals as well? An epidural is a different kind of pain killer, right?
There are different types of medication that can be administered in an epidural. But your thoughts are exactly right. It's definitely better to take pain relievers BEOFRE the pain begins. When's the last time time you were at the dentist and told the her/him to start drilling for a while before giving you the local? Let me guess: Never? Becuase that would be plain silly! But women in labor do that all the time. I'm not talking about those women that don't want any medications and are committed to a "natural birth." I'm talking about women who think theat they want an epidural, or are sure that they want an epidural, but they wait until the pain becomes excruciating before they get it. It makes absolutely no sense. But this is standard practice. I'm trying to explain that it shouldn't be. If you want pain relief for labor, why suffer at all? As I point out in my book, pain itself has a lot of really bad effects for the mother and the baby. In general, for various reasons, you're exactly right - it's better to tak pain meds before the pain becomes severe.
I think to some degree you're being dismissive ...and I support use of epidurals with informed consent (real, unbiased information). I for one have had a sense of guilt having had epidurals and agree that a standard "full epidural" vs a "walking epidural" are two different animals. I think laboring for some time without the epidural is beneficial in one aspect for experience but more importantly it is often hospital policy to keep a mother on a gurney/be with continuous monitoring (bp, ringer iv, 02 sat, fetal hr, possible catheterization) and of course for liability. This is not a good position to labor in for fetal descent, this doesn't help malpositioned babies get into a better position for all involved, this increases the risks for interventions.I think this practice needs some "tweaking" in order to really help reduce risks of epidurals leading to more caesareans, vacumn extraction, low forceps etc.
I will add a qualifier to that and say that I was very adamant in my second epidural birth (walking epidural) that I still be allowed to move around at will and whim and had none of the above problems/risks but the only reason I knew I could fight for this, and it was an argument, was because I am acutely aware of patient rights in my state having worked on the other side of things and being a particularly aggressive patient advocate.
I think more women need to know what their rights are and not be bullied by anyone and that this is really the core of the matter.I see over and over again on this board that women have grown to mistrust the medical community because of bad medical attention they have received. This to me is a huge problem for a variety of reasons not least of which childbirth where women are affraid even at a home birth to call someone in case of an emergency.
I also am a vaguely offended that you would imply that women (especially on this board) can't possibly understand what statistics mean or how peer reviewed studies are conducted. This is naive on your part. There are quite a few nurses, doctors and midwives on this board let alone many other sciences (I'm neurobiology and paramedic sciences, my husband a chemical engineer). The M.D. isn't the only area of study that study these things/learn them in college and apply them in their daily working careers. Perhaps your own patients can't make rational informed choices and for that I'm truly sorry. Also I think you ignore where people might have other strengths that may or may not apply to the matter at hand. For instance in absolutely any medical emergency where there isn't a controlled enviroment I'd bet my home that I react better and more efficiently than you do..not that this applies here but hopefully you get my point.
It's very difficult for someone - whether a scientist, physician, physician-scientist, or (especially) a layperson to critically evaluate a study, peer-reviewed or not, in an area that is not their particular specialty. That's simply a statement of fact, not an indictment of the people on this board regardless of what their (or their spouses) educational backgrounds may be.