1. EPIDURAL ANESTHESIA
By Nancy L. Briggs

2. Epidural for Labor Pain Relief
Most common choice for labor pain
Provides greatest pain relief
Satisfaction reported by women
Availability expected by women

3. Epidural for Labor Pain Relief
Adverse effects on mother and baby ?

4. Effects of Epidural on Labor
Second stage labor & oxytocin
Forcep & vacuum extraction use
Maternal temperature
Maternal blood pressure

5. Maternal Complications
Infection
Hemorrhage
Misplaced catheter/dosing error
Paralysis
Respiratory depression
Death

6. Postpartum Considerations
Urinary incontinence
Low back pain
Spinal headache

7. 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

8. 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

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

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

11. 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),
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:
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),
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, S 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,

12. 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,
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, 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), 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.