Epidural (Case Based Flashcards)

Question 1

Melanie is the woman in your care she is requesting an epidural but is unsure of exactly what it is, explain to her in laymans term how an epidural works and will be inserted

Answer 1

An epidural is medication infusion into the epidural space. It is the most effective form of pain relief in labour. It works by limiting sensation from your waist down. You may still feel the sensation of contractions but they will not be painful. The procedure is performed by an anaesthetist trained in the procedure: they will insert a local anesthetic into your back so you won’t feel pain upon insertion, then the needle will be inserted into the epidural space through the skin and muscle. You will need to also be cannulated so we can run continuous fluids through an IV drip-this will ensure that your blood pressure remains stable

Question 2

Melanie is happy with your response: she then asks you if there are any associated risks with epidurals

Answer 2

Like with all interventions in labour there are some associated risks. Before we perform an epidural if it is okay with you- i will perform a vaginal examination. This examination is to make sure you are in established labour. Research shows that if an epidural is administered in early labour as opposed to active labour it may slow down your progress. By performing the vaginal examination you will be able to make an informed decision. Other significant risks include a possibility that we may have to start a synthetic oxytocin infusion if your labour does slow down. The main complications that we monitor for are hypotension- a drop in your blood pressure which we can treat with a bolus of fluids and positional change. You may experience a post dural puncture headache which may persist this risk is about 1 in 100. There is also a small risk that the epidural will not work and may need to be resited.
Important to know there is an increased risk of intstrumental birth and cesearean. Increased risk of augmentation. The other more significant risks will be discussed by the anethetist.

Question 3

Melanie has asked about common side effects she may need to be aware of

Answer 3

Common side effects after the administration of an epidural include shaking, itching and a possible feeling of coolness. We will be monitoring you regularly for the next 20 minutes following the epidural to ensure that everything progresses normally.

Question 4

Melanie has agreed to the epidural. What do you need to do to set up

Answer 4

Cannulate if not already done so 
Ensure Group and Hold Available Prior to calling anethetist 
Begin IV infusion of crystalloid fluids 
Call the anethetist 
Set up equipment 
Get appropriate documentation 
Put a CTG on her 
Assist her into a flexed supine position

Question 5

What is your role as the midwife throughout the procedure?

Answer 5

Clean the woman’s back with cleaning solution in an aseptic fashion
Pour local anesthetic onto sterile field- state expiry date to the anethetist and check 2x
Pour n. saline onto sterile field - check date with anethetist
Assist the woman into a flexed supine position and work with the anethetist to coach her to remain still throughout contractions
Tape up the back

Question 6

Briefly Describe the Procedure of an EDB insertion

Answer 6

• Local anesthetic injected into skin and subcut area
• Epidural needle placed between L4 and L5 into the epidural space between the ligamentum flavum and the dura mater
• Syringe placed on the end of needle and entry into epidural space is marked by a loss of resistance
• Epidural catheter is threaded through the needle and needle is removed
• Initial bolus of medication given
• Opsite is sprayed onto site to assist it staying in place
• Site is taped in a window around insertion site and threaded onto shoulder that has been cannulated

Question 7

Describe the after care of an epidural insertion

Answer 7

• Record BP 5 minutely for at least 20 minutes & document results on EDB chart and partogram
• If post epidural BP NAD continue to monitor BP half hrly
• Upon anaesthetist instruction set up PCA and PIEB dose on epidural pump
• Monitor pain levels 30 minutely for the first 2 hrs although the anethetist will monitor intermittently
• Educate the woman on how to use PCA and what to expect from an EDB
• Continuous EFM
• Catheterization