Introduction of epidural labor analgesia and its outcomes at muhimbili national hospital Dar es-salaam

Abstract

Background Epidural labor analgesia use is widespread and safe and it gives excellent pain relief. It involves the injection of local anesthetic agent with or without an opiod into lumbar epidural space to produce segmental sympathetic and sensory nerve block. Indications for epidural labor analgesia are maternal consent, medical reasons like patients with pregnancy induced hypertension, parturient with Diabetic mellitus, cardiovascular diseases, respiratory diseases like asthma, sickle cell diseases excites contraindications are refusal of consent, coagulopathy, maternal haemorrhages, maternal sepsis, infection at the site of needle and catheter placement and so on. Advantages of using it is it provides excellent pain relief and cooperation between health attendants and parturient. Disadvantages are the side effect associated with its use in labor and childbirth like prolongation of labor, increase rates of caesarian section and instrumental vaginal deliveries, poor neonatal APGAR score and failure to breastfeed. This study looked at the association between use of epidural labor analgesia and the perceived side effects. Methodology A cross sectional study was conducted among 53 patients who received epidural analgesia with (0.1% 10 mls bupivacaine) for labor analgesia when they were in active phase of first stage of labor. Patients who were admitted in labor ward for delivery had the study explained to them and were told about their rights to decline participation at any stage of the study if they do wish to. Study participants were recruited after being admitted if they met the inclusion criteria and gave informed consent. A lumbar epidural catheter was placed and a bolus dose of (plain bupivacaine 0.1% 10mls) was given. Analgesia was maintained with intermittent bolus doses plain bupivacaine 0.1% 10mls hourly. Participants were followed until discharge from the labor ward. The duration of labor, instrumental delivery and its indication, the neonatal APGAR score and the participants’ satisfaction with the epidural analgesia were documented. Healthcare worker(61) responsible for taking care of these patients were also interviewed after patient was discharged from labor ward using a separate questionnaire which was attached to the patients questionnaire about their opinion of epidural labor analgesia services. The data collected and analyzed with IBM SPSS Statistics Version 20.

Results: A total of 53 women were enrolled. 94.2% of the participants were satisfied and happy with the service and reported that they would ask again for it in future days. 11.3% and 18.6% had prolonged first and second stage of labor respectively, 5.7% had instrumental assisted delivery due to prolongation of second stage of labor. The rate of caesarian section among was 22.6% reasons being (maternal -obstructed labor, cervical dystocia and poor progress being (17.0%) and (1.9%) due to motor weakness and fetal distress 3.7%. APGAR score of the neonates was above 7 score by 92.5%and 98.9% at 1 and 5 minutes respectively. The health care worker participants (61) were also interviewed after introduction of Epidural labor analgesia at MNH 83.6% agreed and among them 29.5% strongly agreed to the routine use of Epidural labor analgesia. The greatest hindrance to routine use of epidural labor analgesia was given as inadequate anesthesia staff, inadequate equipment. 13.1% of healthcare workers thought epidural labor analgesia denies mother’s natural birth experience.

Conclusion and recommendations: From the study it is noted that Epidural labor analgesia was accepted among women as most were satisfied with pain relief and it had manageable side effects. Therefore these pain relief services should continue as they are beneficial to parturient in labor.