Management of labour among women with epidural analgesia

Abstract

To assess current practices in the labour management of low risk primiparous women with epidural analgesia we surveyed delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to 'standard primipara'. Epidural rates among 'standard primipara' at these hospitals ranged from 14 to 85% (median 46%). Continuous epidural infusion was the most commonly used technique (63%). For 'standard primipara' with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing. There is wide variation in epidural availability and in labour management, perhaps reflecting the limited evidence for effective interventions to reduce any unintended effects of epidural analgesia.

Birth outcomes associated with interventions in labour amongst low risk women: A population-based study

“…We also note that where an attempt at vaginal birth is indicated the practice of electively adding oxytocin infusions appears to have become 'routine' once an epidural is in situ. 21,23,27 Mode of birth was recorded as: unassisted vaginal birth, instrumental birth (which included both vacuum extraction and forceps); or cesarean section with labour (we excluded cesarean section where there was no record of the onset of labour. )…”

“…21,23,41,[45][46][47] They are associated with important other maternal complications that require further intervention such as intravenous fluids to attenuate the decrease in maternal blood pressure 23,48 and catheterization to avert urinary retention 21,23 ; and continuous electronic fetal heart rate monitoring throughout the duration of labour. 23,27,41,49 …”

Epidural Analgesia and Fever at Labor

“…К р и т и ч е с к и е с о с т о я н и я в а к у ш е р с т в е и г и н е к о л о г и и тельности на фоне обезболивания [6]. При анализе по лученных нами данных было обнаружено, что родовоз буждение в группе исследования потребовалось в 4 раза чаще, чем в группе сравнения (47,6 и 10,9%, соответст венно).…”

Management of the Second Stage of Labor in Women with Epidural Analgesia

“…We have observed practitioners in the obstetric and midwifery communities regularly discontinue epidural administration once full dilatation is achieved, based on the speculation that this will improve pushing efforts, shorten second stage, decrease instrumental deliveries, and improve perineal outcomes. While the decision to discontinue epidural anesthesia once fully dilated is widespread, there is a surprising lack of research examining its effectiveness 15 …”

“…While the decision to discontinue epidural anesthesia once fully dilated is widespread, there is a surprising lack of research examining its effectiveness. 15 A 2004 Cochrane Systematic Review of five randomized control trials provides the most comprehensive examination of this practice to date. The review specifically compared maternal and neonatal outcomes following second stage epidural discontinuation versus continuation.…”