1.5 - Epidural Care In Labour

Question 1

• Explain how epidural analgesia provides pain relief in labour and outline when this is indicated in labour

Answer 1

• epidural analgesia is inserted through the back
• PCA & continuous infusion
• local
• ropoviance and fentanyl
• drop in BP
• doesn’t cross over the placenta
• IVC
• may feel pressure but pain is rare

Question 2

Explain midwifery care related to epidural insertion and care including monitoring for complication

Answer 2

• IVC
• BP may drop so bolus
• continuous monitoring CTG
• CTG before during insertion and post epidural
• IDC to be inserted
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Question 3

Explain the anatomy and physiology behind epidural analgesia and the mechanism or pathway for transfer

Answer 3

• local anaesthetic inserted into the lower back (lumber area)
• epidural solution given by bolus, continuous, and PCA
• spinal epidural with an opioid give fast onset of pain relief
• creates a band of numbness between the umbilical and upper legs
• blocks nerve pain transmission
• baths the never to become numb and prevents the transmission of pain sensation
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Question 4

Describe the different types of analgesic or anesthesia used in epidural/spinal blocks

Answer 4

• opiods - fentanyl
• idocaine
• bupivacaine

Question 5

Describe the midwifery management for epidurals in labour: including indication, contraindication, and maternal and fetal considerations pre-procedure, during the procedure, post procedure and during second stage

Answer 5

indications

• patient request
• effective analgesia
• hypertension
• preterm labour
• prolong labour
• malpresentation
• cardiac and respiratory health

Contraindication

• maternal reluctance
• sepsis near spine
• haemorrgagic disease or clotting disorder
• neurological disorder
• hypovolaemia or hypotension
• spinal deformity
• chronic back pain

Question 6

Describe the potential side effects and complications that can occur with epidurals in labour

Answer 6

• failure of the epidural
• low blood pressure
• headache
• allergic reaction to the equipment, materials or medication
• respiratory depression, where your breathing slows down too much
• itching
• difficulty passing urine
• temporary leg weakness
• backache
• seizures
• unexpected high block, if the local anaesthetic spreads beyond the intended area
• infection around your spine
• cardiovascular collapse (where your heart stops)
• nerve damage
• blood clot around your spine
• damage to nerves supplying your bladder and bowel
• paralysis or death

Late complications

A complication may happen after the epidural has been removed.

• pus, redness, tenderness or pain
• a high temperature
• feeling unwell
• discomfort when in a bright room or sunlight
• neck stiffness
• difficulty moving or feeling your legs
• difficulty passing urine
• bowel incontinence

Question 7

Identify the information that is important for the woman to know in relation to epidural insertion, management and complication. Is this information different to the discussion with the anaesthetist?

Answer 7

• effectiveness of block
• may not feel the urge to push
• coach the woman during second and third stage
• unable to move
• idc insertion required
• monitor Bromage with ice block
• discuss same complications that may occur the woman may not have really being listening to the anaesthetist due to increase pain
• help the woman stay still whilst insertion of the epidural
• baby may need help to be delivered

Question 8

Has there been a change in epidural use, epidural effectiveness, types of epidural used in current practice and what effect does this have on spontaneous vaginal births or assisted births?

Answer 8

• increase use of epidural
• effective analgesia
• higher risk of assisted birth
• lack of pushing sensation longer second stage and third stage
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