Patient positioning after epidural

[quazar]

How do you position your patients after they have an epidural placed? I have always had them either left or right lateral, with the HOB elevated to a slight semi fowler's to keep the dermatone level at about t-10 and to optimize placental perfusion.

One hospital where I worked, the nurses AND the anesthesiologists would lay the patients flat on their backs after the epidural was placed, and discouraged side lying. Instead they had them lay on their backs and put a wedge under the patient's back.

I was always taught to NOT lie a patient on her back, specifically after epidural placement, for uterine perfusion. I was wondering if maybe I'm missing some current research out there and should be changing my practice? Where I currently work, it's a mix. Some of the nurses lay their patients on their backs, some do side lying and rotate sides like I do.

What is your practice?

ETA: I mean the position your patient is in while laboring after placement, not while pushing or during the actual placement of the epidural.

[offlabel]

Whatever position is comfortable for mom and tolerable for babe. There is no required or recommended position. That said, leaving mom on one side for too long can give analgesia that is greater on one side.

[quazar]

That said, leaving mom on one side for too long can give analgesia that is greater on one side.

Yes, that's why I flip them side to side hourly and check dermatone levels hourly, to keep it even. Is there any research on ideal positioning? I couldn't find anything more current than 2003. :/

[ashleyisawesome, BSN, RN]

Immediately after placement I lay them relatively flat (HOB elevated slightly for comfort), with a left hip roll--this is usually suggested by anesthesia to keep their pressure from dropping. Once I know their B/P is stable and they are relatively comfy pain wise, I position them however they want. Left side, right side, high fowlers, semi fowlers, etc as long as baby is tolerating it. I try to keep them moving pretty often so the epidural doesn't settle to one side or all down in their butt, and to help move labor along. I also try to suggest the peanut ball to all my patients with an epidural, no matter what position they're in.

[mamagui]

I lay the Pt flat, no bump, but the HOB elevated at about a 30 degree angle. I usually only leave them like that for about 20 minutes, enough time so that the epidural has time to set up equally on both sides and rise to abdomen level. After that I usually sit them up higher to whatever position that they are comfortable in. If they like being on their side, I encourage changing sides every 30 minutes or so so that they don't get hotspots.

[lavenderskies, BSN]

I place supine with a L or R lateral uterine displacement hip wedge for about 30 min and then start hourly position changes to L and R lateral and exaggerated L and R sims w/a peanut ball for upper leg support. Occasionally semi folders with open legs (like budha) or hands and knees of the epidural allows.

[lavenderskies, BSN]

I place supine with a L or R lateral uterine displacement hip wedge for about 30 min and then start hourly position changes to L and R lateral and exaggerated L and R sims w/a peanut ball for upper leg support. Occasionally semi fowlers with open legs (like budha) or hands and knees if the epidural allows