Which nursing action is required before a client in labor receives an epidural anesthetic?

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An epidural is the most common form of anesthesia used during labor and delivery. Epidurals provide the best pain relief of all sedation options available for labor, while posing minimal risk to mom and baby. About 60% of women delivering vaginally use an epidural while 95% of women having a cesarean delivery receive epidural or spinal anesthesia. Just like each person is unique, every epidural is different and the outcomes can vary.

What is an epidural?

An epidural is a form of regional anesthesia given through a catheter into the epidural space, just outside the spinal cord membrane. It is administered and monitored by an anesthesiologist and can be given at any point during the course of delivery, as long as the patient can sit still to receive it. Epidurals target the nerves that carry sensation signals, blocking the ability to feel pain while maintaining muscle control, and varying levels of pressure sensation. It is similar to a spinal block, but administered into a different space around the spinal cord. Unlike IV pain medication, it does not cross the placenta, and therefore doesn’t pose a direct threat to your baby’s heart rate or respiratory function.

What are the risks and side effects?

The most common side effect of an epidural is a reduction in mom’s blood pressure. When mom’s blood pressure goes down, it can cause changes in the baby’s heart rate. This risk is routinely averted, however, by giving mom additional fluids prior to receiving an epidural. If mom’s blood pressure does drop, it is usually quickly corrected with medication. Other minor side effects include itchy skin, nausea and vomiting, and a slight increase in temperature. All of these are easily treated and should resolve.

There are other risks, but they are very rare. If the medicine leaks outside the epidural space, it may cause headaches when changing positions. Usually, the headaches are worse when sitting compared to laying down. These typically resolve on their own, but if they persist, they can be treated with a blood patch or caffeine. Other rare risks include the development of a hematoma, or a bruise, around the spinal cord, infection, or abscess. 

Not everyone is a candidate

Women who have bleeding disorders should not have epidurals, due to the risk of hematoma. This includes clotting, platelet or other blood-related issues. Some blood thinning medications may also interfere, depending on when the last dose was taken. In the rare case of a woman with a brain lesion, epidurals are not recommended due to the possible increase in intracranial pressure. And, women who had scoliosis surgery may not be good candidates. If there’s a concern about epidural eligibility, an anesthesia consult during pregnancy can be arranged.

It really is the best, safest option for pain relief

Just like every person is unique, so is every pregnancy. Each person tolerates pain differently. Some women give birth with very little pain, while others experience much more pain. During labor and delivery, it is important to manage pain, and remain calm. An epidural is by far the most common, effective and safe method for pain management during childbirth. Although results can vary, epidurals make labor and delivery more pleasant and safe for mom and baby alike.

Follow along this week as I debunk 8 myths about epidurals in my next blog.

Purpose: Many labor nurses routinely include continuous urinary catheterization (CC) as part of their standard care for women who receive intrapartum epidural anesthesia, to prevent urinary retention, thought to delay fetal descent. Recent studies question use of CCs during labor, as they may predispose patients to urinary tract infections (UTIs), even though the catheters are in place for a relatively short period of time. The objective of this study was to determine the influence of CCs versus intermittent catheters (ICs) (only as needed) on the duration of second stage of labor and the incidence of postpartum UTIs.

Study design and methods: Randomized controlled trial. English-speaking low-risk nulliparous women ≥37 weeks gestation with a single fetus in a vertex presentation who requested an epidural were eligible for participation. Prior to epidural placement, cervical status was documented, women were encouraged to void, and then women were randomized to receive either CC or IC as the method for urinary bladder management for the duration of the first stage of labor. Final sample size included 123 participants; 55 in the CC group and 68 in the IC group.

Results: No differences were noted in length of second stage labor, and the overall incidence of UTIs in both groups was low. There was a significantly increased likelihood of cesarean birth in women who had CC (P < .01) when compared to women who had IC. The overall cesarean rate in the CC group was 27.3%, versus 10.3% in the IC group.

Clinical implications: Intermittent catheterization only as needed appears to be best practice for bladder management for laboring women with an epidural. There was a significantly higher rate of cesarean birth among women in the CC group. The relationship between route of birth and use of continuous indwelling urinary catheters for women in labor with epidurals for pain relief needs more study.

Which nursing consideration is most important when caring for a patient receiving epidural anesthesia while in labor?

How is epidural administered during labor?

What are 2 potential complications from an epidural and nursing interventions to intervene?

When can you get an epidural during labor?