Labor pain is known and defined as one of the most severe varieties of pain. As a result, an appropriate pain management plan is important both for a successful delivery and to decrease pain as much as possible (Poole, 2003). A variety of anesthesia methods for delivery are used in different regions of the world. Epidural anesthesia is the most frequently used method of pain control. It is reliable and is the preferred method of anesthesia for over 50% of hospitalized women in developed countries (Balcioglu, 2004; Camann, 2005; Essam & Arulkumaran, 2005 Lieberman 2004, Robert and Gaiser 2005). Today, the use of epidural analgesia is rapidly on the rise globally. Reasons for this increase include the decreased risk of morbidity, developments in epidural techniques, and women's pain-free delivery experiences (Robert and Gaiser 2005, Vincent and Chestnuta 1998).
Although delivery is a normal physiologic process, it causes a certain level of pain in women. Today, the most frequently preferred and the most used method is epidural anesthesia. The objective of the present study was to review the reasons, effects, and risks associated with epidural analgesia for pain relief. The study was conducted at Akdeniz University Hospital, Antalya, Turkey, between October 2004 and July 2005. Epidural analgesia was administered to 51 pregnant women in the experimental group, and 51 pregnant women in the control group did not receive analgesia. Data were collected by questionnaire and observation forms. Epidural anesthesia was chosen by 76.5% of the participants because they wanted to experience a pain-free childbirth, 66.7% because they were afraid of the process of delivery, 25.5% because they had had a previous bad labor experience, 35.3% because they had people around them with positive experiences, 29.4% because they wanted to have a normal delivery, and 31.4% because they wanted first to see their baby. The overwhelming majority of the participants (94.1%) experienced nervousness before the administration of epidural analgesia. It was determined that epidural analgesia extended the time of labor and increased oxygen and oxytocin requirement but did not increase the risk for interventional delivery and cesarean. To give better obstetric care and control of labor pain, it is of clinical importance to know obstetric anesthesia and analgesics.
Epidural labor analgesia can have positive effects, such as a decrease in mothers' stress as a result of labor pain relief, balancing of respiratory rate and amplitude, lack of disturbance in maternal and fetal acid base balance and uteroplacental circulation, and decrease in blood pressure in preeclampsia. In addition to these physiologic benefits, epidural labor analgesia also provides patients with psychologic comfort and alleviation of excessive pain and ensures that they leave the hospital more satisfied (Bofill et al., 1997). In contrast, Mayberry et al. (2002) found that epidural anesthesia causes maternal exhaustion, which in turn causes the pelvic floor to be damaged and an increase in the incidence of cesarean. Other side effects of epidural analgesia may be cited, such as maternal hypotension, itching, shivering, fever, urinary retention, and dural puncture (Leighton and Halpern 2002a, Lieberman 2004, Mayberry et al 2002).
However, there are some studies showing the contrary, it is reported that epidural analgesia procedure does not increase the percentage of cesarean procedures (Bofill et al 1997, Clark et al 1998, Owen et al 1998, Robert and Gaiser 2005, Sharma et al 1997). According to Nystedt et al.'s (2004) review, with unclear evidence it was difficult to confirm that adverse effects in terms of dystocia and increased frequency of cesarean section were associated with the use of epidural analgesia. In the present study, no cesarean procedures were conducted in either the epidural analgesia group or the control group . This finding is consistent with other studies showing that epidural analgesia does not increase the incidence of Cesarean procedures (Clark et al 1998, Segal et al 1999; Sahin & Owen, 2002). It was determined that women receiving epidural anesthesia required more supplemental oxygen than those who did not receive epidural anesthesia. This may be due to the fact that women become more tired with the increased duration of stages one and two of labor. Essam and Arulkumaran (2005) determined that, although there are benefits to using high-dose oxytocin in both multiparas and nulliparas in advanced labor and for optimal contractions, if the labor process is slow it is necessary to give oxytocin in the first 6-8 hours. In the present study, oxytocin was used regardless of whether women were nulliparous or multiparous. Bodner et al. (2003) determined that there was a difference in newborns' APGAR scores in cases where epidural analgesia was and was not used. The most common side effects related to epidural anesthesia were sedation and nausea. These were followed by shivering, vomiting, itching, hypotension, fetal bradycardia, and ringing in the ears . These findings are similar to those seen in other studies (Leighton and Halpern 2002b, Vincent and Chestnuta 1998). Whereas 68.6% of women who received epidural anesthesia were happy in the fourth stage, this ratio was only 31.4% for women who had not received epidural anesthesia. This shows that women did not feel pain during labor, that labor concluded successfully, that women were aware of all the events during labor, and that they felt comfortable. (El-Hamamy & Arulkumaran, 2005)
The present findings demonstrate that antenatal care and education should be focused on helping women work through their fears and increase their understanding of the process of labor and childbirth. Nurses and midwives who work in primary care settings and in labor and delivery wards need to be given education by experts concerning effects, side effects, potential emergency complications, and the emergency interventions for these complications in pregnant women who are given epidural analgesia.
This article was quoted from http://www.medscape.com/viewarticle/573875_5.
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