The dynamics of epidural and opioid analgesia during labour

Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth?

The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.

Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study

BACKGROUND

Whether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes.

METHODS

This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid.

RESULTS

There were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group.

CONCLUSIONS

0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine.

TRIAL REGISTRATION

Clinical Research Information Service with registration number ChiCTR2100045162 . Registered 7 April 2021.

Intrauterine contraction parameters at baseline and following epidural and combined spinal-epidural analgesia: A repeated measures comparison

OBJECTIVE

The effects of epidural and combined spinal-epidural analgesia on uterine contraction parameters are unclear, although as many as 80% of laboring women use neuraxial analgesia. We explored the effects of epidural and combined spinal-epidural analgesia on all uterine contraction parameters using a retrospective analysis of selected parturients, who required Intrauterine Pressure Catheter (IUPC) instrumentation for clinical management. Additionally, we analyzed the effects of parity, Pitocin dose, and mode of neuraxial anesthesia, i.e. epidural verses combined spinal-epidural on uterine contractility.

DESIGN

Using a retrospective within and between repeated measure design we compared uterine contraction parameters at 4 time points (epochs): (1) baseline, (2) pre-epidural fluid bolus, (3) immediate and (4) secondary post-epidural/combined spinal-epidural analgesia to detect differences in contractility over time comparing two types of epidural interventions.

METHODS

Eighteen healthy parturients at term gestation were admitted to the labor unit for induction, augmentation, or spontaneous labor. Contraction parameters including frequency, duration, peak intensity, resting intensity and duration, and Montevideo Units (MVUs) were collected using fetal monitor strip data with intrauterine pressure catheter (IUPC) instrumentation.

FINDINGS

Parametric and non-parametric tests showed no significant differences within or between the two Epidural intervention groups for frequency, duration, peak intensity, resting intensity and duration, and MVUs at all epochs at the .05 alpha level. Compared with Nulliparous women, multiparous women had significantly lower contraction intensity and longer contraction duration. Based on multilevel modeling (MLM), neither Pitocin dose nor type of epidural intervention revealed significant differences on any contraction parameters.

CONCLUSIONS

When parity, other demographic variables and Pitocin dose were statistically controlled, no uterine contraction parameter changed from baseline through 90 min following either epidural or combined spinal-epidural analgesia. Obstetrical care providers should consider the preciseness their contraction monitoring instrumentation and their clinical management preferences as well parity as before prescribing Pitocin after neuraxial analgesia intervention.

Factors affecting labor duration in Chinese pregnant women

The aim of the study was to explore the role of parity, maternal age, medical interventions, and birth weight with respect to labor duration and cervical dilation.A total of 1601 pregnant women who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome were reviewed. The retrospective study was conducted in patients from West China Second University Hospital of Sichuan University during June 2008 to June 2013.There were 1367 nulliparous women and 234 multiparous women analyzed. The first stage (8.3 ± 3.8 vs 5.0 ± 2.6 hours), latent phase (5.1 ± 3.2 vs 3.5 ± 2.4 hours), active phase (3.2 ± 1.8 vs 1.5 ± 1.0 hours), second stage (44 ± 31 vs 18 ± 14 minutes), and total stage of labor (9.1 ± 3.9 vs 5.4 ± 2.6 hours) were all longer in nulliparous than in multipara women (all P < .05); but no significant difference in the third stage of labor (both 7 ± 4 minutes). In nulliparous women, the average time of first stage of labor increased by 58.257, 171.443, and 56.581 minutes due to artificial rupture of membranes, labor analgesia, and birth weight increased by 1 kg, respectively, but it decreased to 63.592 minutes by oxytocin usage, and the difference was significant. The average time of first stage of labor in nulliparous women aged from 26 to 30 years increased by 2.356 minutes compared to one in 20 to 26 years, but it increased by 1.802 minutes to the one in 30 to 39 years, compared to 20 to 26 years and the difference was not significant. The results were basically similar after multipara women were included.Labor was significantly shorter in multiparous women than that in nulliparous women. Increased birth weight significantly increased in the length of the active phase and the second stage among nulliparous women. The increase of age, artificial rupture of membranes, labor analgesia, and the increase of birth weight tends to increase the time of first stage of labor and total labor duration, whereas oxytocin could shorten it.

Experiences of midwives on pharmacological and non-pharmacological labour pain management in Ghana

BACKGROUND

Due to the debilitating effects of severe labour pains, labour pain management continues to be an important subject that requires much attention. Thus, this study sought to gain a detailed insight into the experiences of midwives on pharmacological and non-pharmacological labour pain management strategies in a resource limited clinical context.

METHODS

A descriptive exploratory qualitative design was adopted for this study which allowed in-depth follow-up of the midwives' comments resulting in a full understanding of emerging findings. Face-to-face individual interviews were conducted, transcribed and data were analysed using content analysis procedures. Verbatim quotes were used to support the findings.

RESULTS

Midwives employed different pain control measures including pharmacological and non-pharmacological methods such as psychological care, sacral massage and deep breathing exercises. Doctors prescribed analgesics most of the time while in some cases, the midwives independently administered the drugs. They assisted women who had epidural anaesthesia given by anaesthetists. The midwives did not administer adequate analgesics because of fear of side effects of analgesics. Although the midwives exhibited knowledge on drugs used for labour pain management, they did not regularly administer analgesics and non-pharmacological care provided were inadequate due to increased workload. Some of the midwives showed empathy towards women and supported the women. Most of the midwives perceived labour pain as normal and encouraged women to bear pain.

CONCLUSION

Midwives require regular education on labour pain management and they should pay attention to women in labour individually and administer the care that meets their need.