Strategies to Support Women Who Have Had an Epidural in Labour

Optimal maternal positioning for fetal descent is achieved by creating positions where the mother is upright, has her upper leg as far as possible away from her lower leg (increasing the transverse diameter of the pelvis) and free space to allow the sacrum and coccyx to move back (increasing the anterior-posterior diameter of the pelvis) (Zwelling, 2010). Zwelling also states that maternal movement and position changes during labour assist with the progression of labour. However, upright positions and maternal mobility can be a problem for many women experiencing obstetric interventions such as an epidural.

There is an increasing trend for women in Australia to undergo labour induction with labour induced in 35% of first time labours in 2014 (Australian Institute of Health and Welfare [AIHW], 2016). The labour induction rate has increased from 25.4% in 2004 (Laws, Grayson, & Sullivan, 2006) to 28.4% in 2014 (AIHW, 2016). Labour dystocia appears to be more frequent after labour induction, and more epidural and non-epidural pain relief is used for induction regardless of parity (Boulvain, Marcoux, Bureau, Fortier, & Fraser, 2001). Australian data shows that in 2014, 34% of women chose regional (epidural/spinal) analgesia (AIHW, 2016). Epidural analgesia may impact the course of labour with an increase in fetal malposition, prolonged labour and an increased need for instrumental delivery (Anim-Somuah, Smyth, & Howell, 2005).

Download the full article here.