Epidural Analgesia and it_s Effect on Labor Outcomes-Phase IV oral pre

Epidural Analgesia and it’s Effect on Labor Outcomes in Women: Phase IV :

Epidural Analgesia and it’s Effect on Labor Outcomes in Women: Phase IV Creighton University School of Nursing Authors: Amanda Bolton Brittany Lob Megan McNamara Mark Sherberg

Purpose:

Purpose Identify factors that effect labor outcomes and the relationship epidural analgesia has on these outcomes.

Significance of the Problem:

Significance of the Problem Cost and Length of stay were two significant statistics that epidural analgesia use influenced. Studies found EA analgesia prolonged length of labor with limited negative obstetrical outcomes. Overall length of stay was increased in women who had prolonged length of labor, and increased instrument assisted delivery methods.

P.I.C.O. Statement:

P.I.C.O. Statement In nulliparous and multiparous women, does the phase of epidural analgesia (EA) use during labor impact the obstetrical outcomes compared to women who do not receive EA.

Summary of the Synthesis of Research Studies:

Summary of the Synthesis of Research Studies

Purpose:

Purpose The overall purpose of these studies was to investigate many different ways that Epidural Analgesia effects the outcome of labor. Cumulatively, they looked at emotional effect, the stage of labor an epidural was administered and its effect, and the overall pain management during labor (1, 2, 3, 4).

Sample:

Sample A total of 17, 574 healthy women of childbearing age They are of various ethnicities, followed during pregnancy and throughout the labor process Populations were both inpatient and outpatient All women represented a diverse population

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1510 Women Total (1) 155 in Epidural Group 1355 in Control Group The Epidural Group included all pregnant women during labor (1). The control group included all pregnant women without epidural analgesia during labor (1). Exclusion criteria Data collection time period and place

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12, 629 Women Requesting Epidural Analgesia (2 ) Requirements Exclusion Criteria Data collection time period and place

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2, 052 Women recruited from Health Centers in San Diego, CA (3 ) Requirements Exclusion Criteria Data collection time period and place

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1383 Women (4 ) Non-probability convenience sample (4). Requirements Exclusion Criteria Data collection time period and place

Level of Evidence:

Level of Evidence One level 2 & three level 4. Randomized controlled trial with high mortality (2) Study Types- Longitudinal, Prospective, and Retrospective (1, 3, 4)

Results:

Results All the studies are related because they measure the outcomes of labor, pain management, and length of labor by use of epidural analgesia. Inconsistencies related to outcomes of epidural analgesia and phase of labor it was given, as well as pain management and birthing process satisfaction (1, 3, 4). In another study, the phase of epidural use did not affect the duration of labor and incidence of cesarean section (2). In two studies they found that extraneous circumstances may influence the labor process and length and it may not only be due to use of epidural analgesia alone (1, 4).

Quality of Evidence:

Quality of Evidence All were moderately well controlled studies All articles had inclusion and exclusion criteria None of the studies had full control of threats or poor control of threats

Consistency of Findings:

Consistency of Findings Two articles contradicted each other in when an epidural should be used during the birthing process (2, 3). One determined that epidural use was a risk for prolonged length of labor with limited negative obstetrical outcomes (1). One come to the conclusion that each experience is individual and therefore needs further research to determine what can be done to help improve the outcome of labor (4).

Recommendation for Practice:

Recommendation for Practice Health care providers need to be educated about the effects of epidural use, when they are indicated for use, and potential risks that are associated with their use.

Clinical, Cost, and Quality Outcomes for Recommendations :

Clinical, Cost, and Quality Outcomes for Recommendations Clinical Remain Free of infection Pain minimized through process Remain free of labor injury Baby and Mother remain healthy and free of hemorrhage or respiratory distress Cost Decreased length of stay in hospital Decreased complications during labor Decreased medical errors during labor Quality Increased satisfaction with experience Decreased anxiety during experience Patient will be knowledgeable of labor process

Recommendations for Further Research and Practice Changes:

Recommendations for Further Research and Practice Changes Dose and Type of epidural can make a difference. Satisfaction with outcome of labor should be measured separately from pain. Newer studies should be done to measure the current practices and should be done in the United States

Interdisciplinary Involvement:

Interdisciplinary Involvement Anesthesiology /CRNA Respiratory Therapy Obstetrician / Midwife L & D Nurse Surgeon Translator

Summary:

Summary There are many clinical factors that influence a positive or negative labor outcome Epidural Analgesia is one of the most prominent issues regarding labor and it is necessary to have a thorough understanding of epidural functions, risks, and what the best clinical practices are using them

References :

References 1. Gerli , S., Favilli , A., Acanfora , M., Bini , V., Giorgini , C., & Di Renzo, G. (2011). Effect of epidural analgesia on labor and delivery: a retrospective study. Journal of Maternal-Fetal & Neonatal Medicine, 24(3), 458-460. doi:10.3109/14767058.2010.498904 2. Gu , X., Guo , X., Shen , X., Peng , Y., & Wang, F. (2009). Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery: A Five-year Randomized Controlled Trial. Anesthesiology, 111, 871-880.

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3. Nguyen, U.T., Rothman, K.J., Dessissie , S., Jackson, D.J., Lang, J.M., & Ecker , J. L. (2010). Epidural Analgesia and Risks of Cesarean and Operative Vaginal Deliveries in Nulliparous and Multiparous Women. Maternal & Child Health Journal, 14 (5), 705-712. Doi : 10.1007/S10995-009-0515-9 4. Waldenstrom, U., & Schytt, E. (2009). Longitudinal study of women’s memory of Labour pain-from 2 months to 5 years after Birth. BJOG: An International Journal of Obstetrics & Gynaecology, 116 (4) 577-583. References cont.