EPIDURAL ANESTHESIA By Nancy L. Briggs
Epidural for Labor Pain Relief • Most common choice for labor pain • Provides greatest pain relief • Satisfaction reported by women • Availability expected by women
Epidural for Labor Pain Relief • Adverse effects on mother and baby ?
Effects of Epidural on Labor • Second stage labor & oxytocin • Forcep & vacuum extraction use • Maternal temperature • Maternal blood pressure
Maternal Complications • Infection • Hemorrhage • Misplaced catheter/dosing error • Paralysis • Respiratory depression • Death
Postpartum Considerations • Urinary incontinence • Low back pain • Spinal headache
Effects on the Newborn • Breastfeeding attempts first 48 hrs. • Crying in first 48 hrs. • Temperature elevations • Separation from mother for observation • Blood draws for sepsis evaluation
Epidural Effects & Complications Educating women • Women have the right to be informed • Women want to be informed • Most women feel they were not informed prior to epidural
Right time Routine office visit during last trimester pregnancy Wrong time In hospital during labor Educating Women on Risks
References • Association of Women’s Health, Obstetric and Neonatal Nurses. (2001). Evidence-based clinicalpractice guideline: Nursing care of the woman receiving regional analgesia/anesthesia in labor. Washington, DC: Author • Courtney, K. (2007). Maternal Anesthesia: What are the effects on neonates. Nursing for WomensHealth, 11(3), 499-502. • Declercq, E., Sakala, C., Corry, M., & Applebaum, S. (2006, October). Listening to mothers II: Report of the second national U.S. survey of women’s childbearing experiences executive summary. In ChildbirthConnection.org Retrieved January 1, 2008, from Childbirth Connection web site: http://childbirthconnection.org/pdf.asp?PDFDownload=LTMII_ExecSum • Heinze, S. D., & Sleigh, M. J. (2003). Epidural or no epidural anaesthesia: Relationships between beliefs about childbirth and pain control choices. Journal of Reproductive and Infant Psychology, 21(4), 323-333. • Leighton, B. L., & Halpern, S. H. (2002). The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review. American Journal of Obstetrics and Gynecology, 186, S69-77. Retrieved December 10, 2007, from CINAHL Plus database. • Lieberman, E., Lang, J. M., Frigoletto, F., Jr., Richardson, D. K., Ringer, S. A., & Cohen, A. (1997). Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics, 99, 415-419.
References • Macarthur, A., J., Macarthur, D., & Weeks, S. K. (1997). Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study. Anesthesia andAnalgesia, 85, 1066-70. • Poole, J. H. (2003, October/November). Neuraxial analgesia for labor and birth: Implications for mother and fetus. The Journal of Perinatal and Neonatal Nursing, 17, 252-267. Retrieved December29, 2007, from Ovid Technologies Inc. database. • Ransjo-Arvidson, A., Matthiesen, A., Lilja, G., Nissen, E., Widstrom, A., & Uvnas-Moberg, K. (2001). Maternal analgesia during labor disturbs newborn behavior: Effects on breastfeeding, temperature, and crying. Birth, 28(1), 5-12. • Riordan, J., Gross, A., Angeron, J., Krumwiede, B., & Melin, J. (2000). The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. Journal of HumanLactation, 16, 7-12. • Tillett, J. (2005). Epidural anesthesia: A resource to use judiciously. The Journal of Perinatal and NeonatalNursing, 19(3), 207-209. Retrieved November 19, 2007, from Ovid Technologies Inc, database. • Wong, C. A., & Peaceman, A. M. (2006). Effect of early epidural analgesia on labor: Cutting through the confusion, Contemporary OB/GYN, 51(7), 64-66, 68, 70.