EPIDURAL ANESTHESIA

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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 Gods opinion that the world should go
on (Carl Sandburg)
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References

• Association of Womens 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
  womens childbearing experiences executive
  summary. In ChildbirthConnection.org Retrieved
  January 1, 2008, from Childbirth Connection web
  site http//childbirthconnection.org/pdf.asp?PDFD
  ownloadLTMII_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.