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

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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  Wrong time

 Routine office  In hospital
visit during during labor
last trimester
pregnancy

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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.

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