“Superficially, obstetric anesthesia appears to be a simple field with a limited range of interest, but it is a deceptively demanding subspecialty. Not only are two patients involved in each anesthetic administration, but also the dynamic events of normal labor require that the muscles concerned with delivery retain their power and coordination to the full.”
by Rachel Ann B. Pedroso
As a nurse, I was not a fan of epidural analgesia. It gives me a headache preparing for so many types of medical equipment: cardiac monitor, cardiotocograph monitor, epidural infusion machine, and if you are lucky, you get a plum A set machine for your oxytocin drip to augment the labor process. You also have to prepare so many forms for legal purposes and documentation.
That statement was a thing of the past. If you ask me again about my opinion regarding epidural analgesia, I will advertise it, especially to primigravidas.
What is epidural analgesia by the way?
Epidural analgesia in labor is a technique used to provide pain-free labor during childbirth. It is usually injected at the lumbar region at L2/3 or L3/4 space.
Before starting the procedures, your responsibility as a monitoring and checking nurse includes:
1. Secure Consent for the Procedure and Type of the Anesthesia with signatures from the OB-Gyne, the anesthetist, and the patient or her husband after a thorough explanation of the advantages, risks, likely complications and management of the procedure.
2. Make sure that laboratory results are in before commencing the procedure especially the Coagulation Profile of the patient. Report any critical values as soon as you received the results for proper management.
3. Do a Time-Out Call. Make sure you bring the right patient with proper surgical attire, calling out the name to the anesthetist and telling the procedure to be done for proper identification purposes.
4. Assist the anesthetist using a strict aseptic technique to prevent infection.
5. Monitor sensory and motor block after catheter insertion. Note the TIME, AMOUNT OF DRUG USED, CATHETER SITE, AND EFFECT OF THE TEST DOSE/BOLUS to the patient.
6. Closely monitor the vital signs of the patient and report immediately hypotension, tachycardia, or loss of consciousness. Occasionally check the sensory and motor block with ice or alcohol swab.
7. Hydrate as ordered by the physician with IV fluids and oral fluids. Aseptically insert foley’s catheter because the patient will have less sensation to void. Secure it with a plaster at the thigh.
8. Always check fetal monitor for non-reassuring CTG reading, decelerations, fetal distress, bradycardia and immediately notify the OB-gyne.
9. Watch out for spontaneous rupture of membranes, bloody show, uterine contraction, and crowing of the fetal head.
10. Report immediately to the anesthetist if the patient feels the pain to titrate the infusion as per patient’s pain relief demands.
Epidural analgesia is expensive and it is always an informed choice for the couple. However, OB-Gyne’s highly recommends during:
a. nullipara or primigravida cases
b. prolonged labor with maternal exhaustion due to unacceptable levels of pain
d. difficult forceps delivery
In my experience as a nurse, our anesthetist prefers using fentanyl as the opioid of choice. Its principal effects are analgesia and sedation with some signs of respiratory depression, sedation, and drowsiness. Oxygen inhalation via the face mask is ready with 10L of air. Checking the blood pressure, pulse rate, and SP02 levels is a must. Also, make sure that you have Ephedrine at the bedside to counter hypotension and atropine to reverse bradycardia.
Here are some important points to consider before telling your OB-Gyne that you want an epidural block during delivery. The source of these data is the American Family Physician online site. I’ll post the link at the end of my write-up for a thorough explanation of the procedure.
Advantages of Epidural Analgesia
Provides superior pain relief during first and second stages of labor
Facilitates patient cooperation during labor and delivery
Provides anesthesia for episiotomy or forceps delivery
Allows extension of anesthesia for cesarean delivery
Avoids opioid-induced maternal and neonatal respiratory depression
Contraindications to Epidural Analgesia
Pregnant women should be well informed about the course of labor and delivery especially the kind of pain they will get during uterine contractions. Pain relief modalities should each be explained to them thoroughly and let them be proactive in the kind of care they would want to avail. Aside from childbirth classes which taught about Lamaze method, deep breathing and pursed lip breathing techniques, guided imagery, distraction technique and meditation as pain control techniques, Epidural analgesia, should be presented to them objectively in full package with the advantages, disadvantages, and risks and complications. Careful patient evaluation of the patient is a must.
Childbirth, with all the pain that a woman must endure, is a heroic experience. With modern technology, labor pain can be controlled with meticulous pain management procedures like Epidural Analgesia in Labor. If you are curious, go to your nearest OB-Gyne for a good explanation.
Cheers to motherhood!