Delivering fetal demises

[sharonx]

Our anesthesiologists are refusing to do epidurals on mothers delivering a stillborn. They think that other meds are appropriate and enough because at this point we don't have to worry about harm to the baby. We think pain management would be so much better with an epidural. We cannot seem to find any research on this topic. I cannot believe that this is standard procedure. What is everyone else out there doing for these patients and if anyone has research articles, that would be so helpful to defend our case for these moms.

[klone, MSN, RN]

We've done morphine PCA for pain management in labor with an IUFD.

Edited to add: Sorry, meant to add that yes, our anesthesiologists will still place a CLE if the patient wants one.

[cleback]

Wow I'm surprised there has been no research on this. Following the thread. I would not think a morphine pca would cut it without being too sedating.

[TREC96]

Everyone is offered an epidural. Just because the baby has died does not lessen the pain of labor. And is practice allowed by the OB?🤔

[meanmaryjean, DNP, RN]

Not an OB nurse, but how barbaric! I'm guessing these are all men?

[NicuGal, MSN, RN]

Why are they refusing? That excuse is not one, labor is labor. You all need to take that up the chain of command and be an advocate. All our mothers are offered an epidural.

[offlabel]

Are these all unexpected demises or are some of them elective inductions for fetal anomalies and there is an ethical objection?

If they're refusing these in the case of true still borns, it's odd because it's a billable procedure and they're turning down money. But on the other hand, how many of these can there be? Not a whole lot I'm guessing. The OB's should complain to the hospitals medical executive committee who should tell the anesthesia group to play ball because there are other groups that would be happy to.

[sharonx]

This is what we are trying to have offered to our patients. The anesthesiologists come and do a consult but do not offer this. We are trying to gather EBP.

[sharonx]

We only do elective inductions for fetal demises. So ethics should not be an issue for any of them. We are trying to bring this up the chain of command but want to gather EPB if possible.

[offlabel]

We only do elective inductions for fetal demises. So ethics should not be an issue for any of them. We are trying to bring this up the chain of command but want to gather EPB if possible.

What is EPB?

[klone, MSN, RN]

What is EPB?

Evidence Based Practice

[chare]

…We are trying to gather EBP.

If, by EBP you mean randomized controlled studies, I doubt that you will find any, at least none that are current. If offering laboring mothers an epidural is the standard of care, you would have to assign half of your patients to receive a level of care below the accepted standard. As the epidural provides benefit to the mother, and not the fetus/neonate, I don't see how the fact that a fetal demise has occurred has any bearing and seriously doubt that any institutional review board is going to approve that.

What does your OB group think of this? If they think that an epidural should be offered, then I agree with offlabel. As this is a medical practice issue the OB group should take this to the medical executive committee. If the OB group doesn't see this as an issue, then the nursing staff should address their concerns with the OB group.