To Epidural or
not…That is the
question??
Ashley Rigby
Brittney Bunnell
Heather Lee
Erika Highstead
Lumbar Block
Overview
Involves injection of a local
anesthetic agent into the epidural
space
Space between the dura mater and
ligamentum flavum
Assessed through lumbar area
Block the Pain
 Technique most often is a continuous
block
 Start of Active Labor through the
episiotomy repair
 Pain Relief is achieved in 85% of women
 12% experience partial relief
 3% no pain relief
Cultural FactorsFrance
 Epidural during labor is suppose to be
available to all women
 8,233 low risk women were selected
 2,720
 37% decided not to have one
 43.9% labor occured to quickly
 3.3% medical contraindications
 2.8% anesthesiologist not available
Cultural Factors- U.S.
Medicaid Woman of Georgia
29,833 Met Criteria
15,936 (53.4%) Chose to have
epidural
Cultural Factors- U.S.
 Racial and Ethnic Comparisons
 African Americans 49.5%
 Hispanic: 35.5%
 Asian: 48.1%
 White (non-hispanic) 59.6%
 Race/ethnicity a significant predictor of
epidural analgesia
Signs and Symptoms
Some women come into labor with
the intention of having a natural
labor but the pain can be too much
and they can change their mind
The main sign or symptom to give
an epidural is pain
Effects of epidural on
Laboring mother:
 Hypotension: this can cause decreased
blood flow to the fetus
 Fever over 100.4
 Decreased mobility, inability to urinate
 Nausea/ vomiting
 Pruritus
 Sedation and Drowsiness
 3rd and 4th Degree lacerations
Effects of Epidural on
Fetus during labor
Fetal Malposition
Fetal Heart rate abnormalities
Tachycardia or bradycardia
Late or variable decelerations
Meconium stained fluid
Effects of progress of
labor/effects on mode of delivery
 Increased use of
ptocin
 Decreased rate of
dilation
 Diminished ability
to push
 Longer labor over
all
 Reduced chance
of spontaneous
vaginal delivery
 Instrumental
vaginal delivery
Effects on maternal
postpartum
Urinary retention/incontinence
The following are rare but serious:
Meningitis
Postdural puncture seizures
Cardiorespiratory arrest
Vertigo
Effects on newborn
Increase in hyperbilirubinemia
There are studies that show there is
a relationship between the success
of breastfeeding right after delivery
and whether the mother was given
an epidural or not.
Toxic affect of Epidural
 Toxic effects due to anesthetic overdose
primarily effect the Central Nervous System and
Cardiovascular System. The nervous system is
more susceptible to toxicity; therefore, will be
the first to show signs followed by the
cardiovascular.
 CNS: Tinnitus, Dizziness, Seizures, Abnormal Taste
 CVS: Bradycardia (no adrenaline in drug),
tachycardia (if there is adrenaline), arrythmias,
Bupivacaine is considered to be the most
cardiotoxic
Impact on Nursing
Care:
Rise in elective C-sections because
of "pain free delivery"
Higher risk patient?
 potential complications
longer labor
FHR
Impact on Nursing
Care:
Nurses work load increases slightly:
 acts as advocate to correct information
 monitoring of V/S and FHR
 risk for Hypotension----preloading
 Temporary changes in bowel elimination and
placement of catheter
 Administering single doses, or "topping it off”
 another site for possible infection
 monitoring for side effects
Impact on nursing
care:
 Nursing care benefits
 Mom's in less, or no pain = less call light use
and uncomfortableness
 makes transitioning through labor and being
able to save energy for the delivery and
recovery
 Easier to make a connection and help the
mom get through labor
Interventions/
Treatment
 Pre-Epidural
 IV Fluids
 Education
 Advocate
 Vitals
 Assess Labor Progress
 Check Lab Values
 Answer any questions
Interventions/
Treatment
During Epidural insertion:
Positioning
Support
Help woman with breathing technique
Alert anesthesiologist when
contractions occur
Monitor maternal and fetal vital signs
Interventions/
Treatment
Post-epidural
Assist patient into position
Monitor maternal blood pressure
1:1 nurse- patient care
Indwelling catheter
Monitor temperature
Constantly communicate
Implications on
Nursing Practice
Effects on Breastfeeding?
Are the side affects worth it?
Pain being “unatural”
Effects during labor- injuries?
References
• Durham, J. (2003). Side effect of epidurals: a
summary of recent research data.
International Journal of Childbirth
Education, 18(3), 11-17.
• Davidson, M.R., London, M.L., Ladewig, P.A.
(2008). Maternal-Newborn Nursing and
Women’s Health Across the Lifespan.
Pearson Education, Inc. Upper Saddle
River, New Jersey.
• Goodfellow, C.F. (1983). Oxytocin in Epidural
Analgesia. British Journal of Obstetrics and
Gynecology, 90, 214-219.
• Rust G, Nembhard W, Nichols M, et al (2004).
Racial and ethnic disparities in the provision
of epidural analgesia to Georgia Medicaid
beneficiaries during labor and delivery.
American Journal of Obstetrics and
Gynecology, 191 (2), 456-462.
• Le Ray C, Goffinet F, Palot M, et al (2008).
Factors Associated with the choice of
Delivery without Epidural Analgesia in
Women at Low Risk in France. Birth, 35(3),
171-178.