EPIDURAL ANESTHESIA

By Nancy L. Briggs

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Epidural for Labor Pain Relief

Most common choice for labor pain Provides greatest pain relief Satisfaction reported by women Availability expected by women

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Epidural for Labor Pain Relief

Adverse effects on mother and baby ?

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Effects of Epidural on Labor

Second stage labor & oxytocin Forcep & vacuum extraction use Maternal temperature Maternal blood pressure

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Maternal Complications

Infection Hemorrhage Misplaced catheter/dosing error

• Paralysis• Respiratory depression• Death

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Postpartum Considerations

Urinary incontinence Low back pain Spinal headache

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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

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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

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Educating Women on Risks

Right time Routine office

visit during last trimester pregnancy

Wrong time In hospital

during labor

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A baby is God’s opinion that the world should go on (Carl Sandburg)

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References Association of Women’s Health, Obstetric and Neonatal Nurses. (2001). Evidence-based clinical practice

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 Womens Health, 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.

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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 and Analgesia, 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 Human Lactation, 16, 7-12.

Tillett, J. (2005). Epidural anesthesia: A resource to use judiciously. The Journal of Perinatal and Neonatal Nursing, 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.