Epidural ANESTHESIA… Use of Epidural Research Paper

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(Stremler, Halpern, Weston, Yee & Hodnett, 2009, p. 391). (De Sevo, M. & Semeraro, 2010, p. 11) the implications being that the overmedicalization of the labor and delivery process has been well intrenchend in nursing culture and may influence increased rather than decreased medical intervention use for women, even when they would not necessarily have needed it. The challenge to nursing is then to begin to support a reduction in the use of epidural anesthesia as a result of the fact that this comfort measure has been over utilized despite its long list of known complications, some minor and short lived and some very serious. One of the issues that needs serious address in the nursing context with regard to the use of epidural anesthesia is the procedural policies associated with additional medical intervention required with epidural placement. Nurses need to be advocates for changing some of these mandatory intervention implementation care plans. Some examples important examples are mandatory urinary catheterization, and severe limitations of movement, and other less medical comfort measures during labor once an epidural is placed. In a great example of this need for advocacy is offered by Stremler, Halpern, Weston, Yee & Hodnett,

Given the potential beneifits of hands-and-knees positioning, it may be especially important to examine its use for women laboring with an epidural given that use of epidural is associated with persistent malrotation, longer second stage, use of oxytocin, and instrumental delivery …Because these deleterious outcomes may be related to pelvic floor laxity and less efficient descent and rotation through the birth canal, increasing mobility and optimizing relationships between the maternal pelvis and fetal head through the use of hands-and-knees may be beneficial (2009, p. 391).

These researchers contend that movement restrictions and other mandatory medical interventions used concurrently with epidural anesthesia should be challenged.

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Increasing the options available to those who chose epidural anesthesia that might mitigate some of its shortfalls would go far in melding the practice into safer and more comfortable labor for thousands of women.

Conclusion

Reducing the ideation of the epidural as the "standard practice" regarding labor and delivery in the modern era will likely go far in reducing the medical intervention stresses of the labor and delivery area. Nurses must become advocates of utilizing epidural anesthesia as a helpful but potentially risky aspect of labor and delivery as well as challenging some of the mandatory medical restrictions and interventions as a result of its use. Epidural anesthesia practice has improved substantially over the last 30 years to mitigate some unintended consequences of its use. Regardless it has also correlated to increased unintended complications for many women and increased need for alternative medical interventions, instrument use, prolonged labor and reduced fetal health, that may not have been the case at all had epidural anesthesia not been introduced in the first place.

Resources

De Sevo, M.R., & Semeraro, P. (2010). Urinary Catheterization During Epidural Anesthesia. Nursing for Women's Health, 14(1), 11-13. doi:10.1111/j.1751-486X.2010.01502.x

Peirce, C.C., O'brien, C.C., & O'Herlihy, C.C. (2010). Postpartum femoral neuropathy following spontaneous vaginal delivery. Journal of Obstetrics & Gynaecology, 30(2), 203-204. doi:10.3109/01443610903477531

Stremler, R., Halpern, S., Weston, J., Yee, J., & Hodnett, E. (2009). Hands-and-Knees Positioning During Labor With Epidural Analgesia. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(4), 391-398. doi:10.1111/j.1552-6909.2009.01038.x

Welliver, D., Welliver, M., Carroll, T., & James, P. (2010). Lumbar Epidural Catheter Placement in the Presence of Low….....

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