In 2001 the Nature and Management o...

In 2001 the Nature and Management of Labor Pain symposium (see Leeman, et al., (1) in this issue) brought together family physicians, obstetrician--gynecologists, nurse-midwives, childbirth educators, and anesthesiologists for a critical analysis and discussion of systematic reviews upon labor pain. (1) The symposium occurr in the words immediately preceding [i]or[/i] following of the increasing use of epidural analgesia, which is now used in almost sum of two units thirds of labors in the United States. (2) Presentations showed that epidural analgesia is a more effective pain-relief order than intravenous narcotics, (3,4) the inferior most common pharmacologic method of pain relief (used in 30 percent of labors). (25) In the First National U contemplate of Women's Childbearing Experiences, (2) 78 percent of women rated epidural analgesia as real helpful.

Most women in the United States deliver infants in hospitals where epidural analgesia or intravenous narcotics are the simply pain-relief options. Alternative pharmacologic rules for pain relief, including nitrous oxide and paracervical blockades are used infrequently in the United States. Despite numerous studies showing that use of doulas and continuous labor support be the effects in a de-creased need for medical intervention, improved maternal and newborn issues and increased maternal satisfaction, small in number women are afforded this option. (6)

Although epidural analgesia clearly is a highly effective and popular system of providing labor analgesia, it has significant potential side general intents Symposium presentations showed that epidural analgesia may increase the long duration of labor, the need for operative vaginal delivery, and the likelihood of perineal laceration. (47) Epidural analgesia can cause maternal agitation with consequent increased use of neonatal antibiotics and sepsis evaluations. (47) Whether epidural analgesia springs in a higher rate of cesarean delivery or is a confounder based upon its use in "difficult" labors remains a point of lawsuit Physicians who frequently use epidural analgesia may have a maternity practice turn of expression that leads to higher cesarean rates as a end of earlier hospital admission, increased use of oxytocin augmentation, and decreased appearance of the physician. (8)

The childbirth take a view of showed that many women are poorly informed about the potential side validitys of epidural analgesia. (2) To make an informed choice, women should be told of the risks and benefits during prenatal care rather than in the midst of labor. Symposium participants acknowledged the scarcity of data about the imports of epidural analgesia on newborn behavior, breastfeeding, and maternal-infant bonding, and they highlighted the ne for to come research in these areas.

A technologic birthing example that uses labor induction, epidural analgesia, continuous electronic fetal monitoring, and cesarean delivery increasingly dominates labor and delivery wards in the United States and other industrialized countries. conversation participants expressed concern that when institutional epidural rates are high, other meanss of labor support, such as childbirth classes, doulas, pampers trained in supporting nonmedicated childbirth, and availability of other pain rule modalities, may not be proffered In many hospitals, labor pain management options are limited to epidurals, parenteral analgesics, or rudimentary labor support from overextend pampers An anesthesiologist at the symposium remarked that "While there may be question s with high epidural usage, in the neighborhood of our nursing shortages and economic or business considerations, having a woman in bed, attached to an intravenous line and continuous electronic fetal monitor and in receipt of an epidural may be the single realistic way to go."

Access to professional labor support is considered a voluptuousness for patients in most U hospitals, and lack of access to epidural analgesia may consequence in legal action. (9) The issue of patient choice is being used as a pretence for increasing technologic intervention in the birth proces A past president of the American corporation of Obstetricians and Gynecologists called for the right of a patient to cull cesarean delivery in the absence of maternal or fetal indications, (10) and the American Society of Anesthesiologists remind ofs closing smaller hospitals that are unable to support universal access to epidural analgesia. (11) However, neither organization advocates a broader range of labor support and pain management options to aid patient choice. Brazilian women are "choosing" cesarean delivery partly disclosed of concern that they won't receive adequate medical care during labor. (1213) Similarly, in many hospitals, American women may be warmed that epidural analgesia is the and nothing else real choice they have.

Family physicians providing maternity care may be excited "out of the loop" as a outcome of the predominant use of epidural analgesia for labor pain. The ask for for epidural analgesia may be wafted to the anesthesiologist by the nursing staff, with alone a perfunctory nod from the primary caregiver. In contrast to this inappropriate tendency the request should be viewed as a consultation. (14) As with any consultation, the family physician has the responsibility to be a knowledgeable advocate for the patient--taking the time to learn which epidural put drugs intos and techniques are used in a specific hospital and understanding their effectiveness, potential side tenors and limitations.