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

Educating Women on Risks Right time Routine office visit during last trimester pregnancy Wrong time In hospital during labor

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

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.

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.