Re: [ozmidwifery] Epidurals

[GayeLeanne]

Hi Everyone,
  Out of interest to you all I work in a large tertiary hospital where 2-4 inductions/day are booked, mainly due to post-dates ( Term + 10 -14/7 ), but also obstetric complications of maternal and fetal origin, and Term PROM. Both Prostins and ARM are used based on the Bishops score. After ARM, assuming no complications, women are given 1 - 4 hours to establish significant contractions  themselves to avoid a Syntocinon drip, or to Iabour within 24 hours in the case of Term PROM. I consequently see a large number of Epidurals used for pain relief, and also to lower blood pressure in pre-eclamptic women.
    Whilst we, as midwives, may not all agree with these protocols, it is our duty of care to ensure our patients are fully informed of their individual options and supported in their choices. I concede it is difficult to do this effectively when I meet them for the first time in Birth Suite, especially with no antenatal education. It would be nice for us if all women were pro-active in determining their birth plan in advance in collaboration with their primary care-giver, be it GP, Obstetrician , or midwife, but sadly as we all know this is not the case with many women arriving at hospital for their baby's birth with no knowledge of the birth process, let alone knowing the effects of analgesia on bonding or breastfeeding. While it isn't my intention to debate here the pitfalls of a pregnant woman's access to information on antenatal education in the public health system, we know lack of education can contribute to the high number of inductions and epidurals we see, eh!
   Having said that as Monica mentioned, not every woman who consequently seeks an Epidural is suitable for one, like her patient with the deteriorating COAGs. Recently I cared for a woman with the opposite problem, i.e. Thrombocythaemia, where the anaesthetist feared haematoma formation in the epidural space, and so a PCA was recommended for pain relief, if required. I've also seen a PCA used on a morbidly obese woman to control her pain and thus lower her blood pressure, when the anaesthetic registrar and consultant both failed in their many attempts to site a working epidural. While not the analgesic of choice in most cases, I hope, I can see where a PCA has a place.
     Cheers, Gaye.