Just returned on Sunday from the UCSF OB anesthesia meeting, held annually in San Francisco, and I can say that I really enjoyed the conference. It was very informative, interesting, and San Fran's a great city to have a conference in. However, I saw the real estate section in the paper, which reaffirmed my decision not to live out there. A pearl or two from the conference:
There has been a study done on the effect of epidurals on the duration of labor. Now, for a long time, common wisdom has held that epidurals, while great for a mother in pain, can significantly slow the progress of labor. Many OB's and anesthesia providers have also felt that putting in epidurals too early (4 cm dilation seems to be the magic cut off) can even put a temporary halt to labor. The data of this study suggests something many of us have long suspected. Neither of these common wisdom assumptions are borne out by the data. In fact, the timing of the epidural has little or nothing to do with the progress of labor, and epidurals may actually shorten the duration of phase I of labor. The information was presented by one of the study's investigators, and his words were the only reason he could see to delay putting the epidural in a patient who desired it was because you wanted the patient to experience the pain associated with labor. (Said with smirk on face.)
Post epidural infections were also discussed. There are a lot of us (myself included, I must confess) who learned that it was not necessary to wear a surgical mask when doing a neuraxial anesthetic. There is a case of a parturient who died about 24 hours after epidural from bacterial meningitis. When the bacterial culprit was cultured, it was found to be an exact DNA match for bacteria cultured from the anesthesiologist's nose. (Not at all a slam on the provider. There are a LOT of us who don't wear masks when placing epidurals. I will from now on, however.) Interestingly, a confidential survey of anesthesiologists in Australia found that something like 1% felt that sterile gloves were unnecessary for epidural placement. So maybe not wearing the mask isn't the worst thing you could be doing.
We were also addressed by a CNM who provided data on other methods of labor pain management. Like most midwives, this woman appeared to have a definite bias against epidural pain management for labor, but did provide some very interesting data reported by women after delivery. Various modalities were tested and patients were surveyed about what they found most effective for helping cope with labor pain. The methods that are most often used, breathing and position changes, were rated the least effective. Use of a warm bath or warm shower for labor (not to be confused with water birth) were the most efficacious of the non-epidural pain management techniques. In fact, 49% of women found that immersion in a tub was very helpful in dealing with labor pain, and 32% found that a shower was very helpful. (Interestingly, a point mentioned, but downplayed, found that 78% of women rated the epidural very helpful. The survey also failed to ask women how they felt about using a tub used by 250 other laboring women.)
Anyway, I met several people at the conference who make it a point to attend the UCSF conference annually. I don't know that I'll do that, but I will go back.
