[Maintaining epidural anesthesia by the midwife]

Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively, a continuous epidural infusion procedure can be used. The last method, however, sometimes requires the administration of additional epidural "top-ups". There are some risks in administering additional "top-up" dosages. The possibility exists of the anaesthetic causing a spinal block as a result of being administered into the spinal fluid. The "top-up" can also cause convulsions if administered intravenously. In some units it is expected of the midwife to maintain epidural anaesthesia on prescription by the doctor. These side-effects can, however, also occur when the patient is being treated by medical personnel with ample experience and knowledge. It is expected of some midwives to maintain an epidural block on prescription by the anaesthetist. If the midwife lacks the necessary knowledge of epidural anaesthetic and its maintenance, she might unintentionally administer the local anaesthetic into the spinal fluid or intravascularly. This might cause a threat to the mother's and baby's lives. This research covers the maintenance of epidural anaesthesia as carried out by the midwife. The level of involvement of the midwife in the maintenance of epidural anaesthesia has been investigated. The midwife's knowledge about the maintenance of epidural anaesthesia, her legal rights, obligations and emergency treatment of patients have been investigated. It has also been considered whether protocols in the maintenance of epidural anaesthesia exist. All the abovementioned information was acquired by submitting a questionnaire for completion by midwives practising in labour wards in the Johannesburg area. The results of this research show that the midwife's knowledge as regards to epidural anaesthesia and its maintenance is inadequate.(ABSTRACT TRUNCATED AT 400 WORDS)