epidurals

ldyrn · Jun 7, 1999

Our labor and delivery unit does 300-340 deliveries a month with an epidural rate of 40-50%. Our patients receive a 1000cc Lactated Ringers IV bolus(unless on a fluid restriction), and an oral antacid (Bicitra) prior to the placement of the epidural. The fluid bolus potentially alleviates any precipitous drops in the patients blood pressure. Our L&D RN's assist with patient positioning during the procedure. Blood pressures are recorded prior to the start of the epidural, when a test dose is administered, when a bolus dose is administered, and q 5-15 minutes until stable per the RN's and anesthesiologists discression. After one hour of stable BP's, BP's can be recorded q 30 min until delivery. FHR and contrx are recorded at these intervals also. The anesthesiologist must also be present for the patient's delivery. Our patients are kept NPO or ice chips only after placement. The anesthesiologist also gives BP parameters to be notified if abnormal. Hope these guidelines help! I'd be interested in hearing how other birth centers policies may differ.

Tired · Aug 26, 1999

Our hospital does around 50-90 deliveries a month. (We were bought out, and the new owner has lost several insurance carriers) We are a small unit, 10 LDRP suites. We have a CRNA on staff 24 hours a day. We have an epidural rate of about 90%! I think we must have a very wimpy group of mothers here! Anyway, our protocol is the same as the previous response, pretty much down to the letter, except that we don't routinely give the bicitra. We monitor the BP very closely after insertion and the test dose, usually q 3-5 mins for 20-30 mins. My experience is that if the BP is going to drop, it will do so within that time limit. We also routinely apply O2 per NC for a while after insertion. This is an anesthesia protocol. Also, we will wedge the patient to her L side with a rolled pad to take the pressure of the baby off the Vena Cava. That's another anesthesia protocol. All these steps aid to prevent what we affectionately call "post-epidural syndrome". The drop in pressure will cause the FHT to drop dramatically, and sometimes it just refuses to recover! When that happens, it is a race to our OR. We have a low C/S rate, 11-13%, so we must be doing something right. I hope this helps. I would get in touch with the anesthesia dept in your facility to see if they have a policy on epidural monitoring. Good luck!