Labor analgesia is an academic term in clinical obstetric medicine and is often referred to as "painless delivery". Generally speaking, "painlessness" is only an idealized state, and it is more difficult to achieve in childbirth, and people often use various methods to reduce the pain during childbirth.
Commonly used methods include non-pharmacological analgesia and pharmacological analgesia. Among them, non-pharmacological analgesia includes methods such as mental comfort, acupuncture, transcutaneous electrical stimulation, and underwater delivery; Pharmacological analgesia includes laughing gas inhalation, durolin intramuscularly, diazepam orally, and perineal local block or paracervical block performed by an obstetrician. The neuraxial injection analgesia method is the third method independent of the first two, and it is currently recognized as the most reliable, widely used and feasible analgesic method with an analgesic effective rate of more than 95%.
However, this very effective analgesic method has certain difficulties in its implementation.
First of all, there is a shortage of anesthesiologists in the country, which has led to a significant increase in the work intensity of anesthesiologists. Failure to be on duty may result in delays or cancellation of labor analgesia.
Secondly, women often ask for "this needle must be good", and this technique is not 100% successful. For example, there may be puncture failure, complications during the puncture, and poor analgesia.
Thirdly, after the anesthesiologist completes the puncture, he or she will generally return to the anesthesiology department as soon as possible. Therefore, the observation of maternal analgesia usually falls to the midwife. However, midwives lack the basic theory and techniques of anesthesia to accurately judge the situation and even detect abnormalities in time.
Suffice it to say that the popularity of labor analgesia could be a big problem if the shortage of anesthesiologists is not addressed.
However, the involvement of nurse anesthetists in labor analgesia may be a solution.
The advantage of nurse anesthesiologists is that they master the basic theories and techniques of anesthesia and can assist anesthesiologists in the operation and management of labor analgesia. In addition, the nurse anesthetist can closely observe the woman and assess the analgesic effect after the anesthesiologist leaves. More care also helps to reduce maternal pain.
So, how can nurse anesthetists get involved in labor analgesia care?
(1) Publicity and education of labor analgesia. Nurse anesthesiologists educate women on labor analgesia when they enter the delivery room, including the principles and methods of neuraxial labor analgesia, analgesic effects and safety, and key points of anesthesia cooperation.
(2) Preanesthesia care: strictly grasp the indications and contraindications of neuraxial anesthesia. The anesthetist will conduct a preliminary anesthetic assessment for the women who can be analgesic for labor, and assist the anesthesiologist to sign the anesthesia informed consent form after the assessment meets the indications for anesthesia.
(3) Anesthesia nursing: assist the anesthesiologist to complete the anesthesia of labor analgesia. The anesthetist nurse prepares drugs and supplies in advance, assists the mother in setting up the anesthesia position, and informs the mother of the key points and precautions for anesthesia. During the anesthesia process, the anesthetist nurse cooperates with the anesthesiologist to anesthesia and configure the analgesic pump, sets the parameters of the analgesic pump according to the doctor's instructions, fixes the epidural catheter after the anesthesia is completed, connects the PCEA analgesic pump and informs the mother of the role and use of the PCEA analgesic pump and the precautions after anesthesia, and finally completes the relevant anesthesia records and charges.
(4) Post-anesthesia nursing: closely observe the maternal condition and carry out dynamic analgesic management.
(1) The anesthetist nurse closely observes the vital signs, lower limb movements, uterine contractions and fetal heart rate of the mother; Observe whether the mother has anesthesia-related complications such as nausea and vomiting, urinary retention, skin itching, fever, etc., and treat the symptoms in time if there is any abnormality;
(2) Dynamically evaluate the analgesic effect of mothers, evaluate and record pain scores once every half hour, and adjust the dosage of analgesic pumps in time according to the doctor's instructions for women with pain scores of ≥ 4 or no pain and contractions;
(3) After the uterine ostium is fully opened and enters the second stage of labor, the anesthetist nurse will reduce the dose of the PCEA analgesic pump or temporarily close it according to the mother's feeling and pain of contractions;
(4) After the delivery of the fetus in the third stage of labor, the anesthetist nurse will add the dose of analgesic according to the actual situation of the mother to reduce the pain during perineal suture, and at the same time guide and comfort the mother's emotions after delivery;
(5) 2 hours after giving birth, before the mother leaves the delivery room, the anesthetist assists the anesthesiologist to pull out the epidural catheter of the mother, and informs the mother of the relevant precautions: pay attention to prevent falls when getting out of bed for the first time, do not get wet at the epidural puncture point within 24 hours, and encourage normal breastfeeding after labor analgesia;
(6) Within 24 hours after delivery, the anesthetist nurse will follow up and record the analgesia of the mother, and the follow-up content is mainly whether the mother has anesthesia-related complications, the epidural puncture point and the satisfaction with labor analgesia.
It should be noted that the nurse anesthetist will definitely not be satisfied with the involvement of nurse anesthetists in labor analgesia care. At this stage, there is a shortage of anesthetist nurses in every hospital, and it is impossible to be in the delivery room 24 hours a day. To this end, it is key to increase efforts to train nurse anesthetists.
Compared with training anesthesiologists, it is less difficult to train nurse anesthetists. Because the most important thing for anesthetist nurses is not how to operate, but to make accurate observations, deal with them at the first time, and notify the anesthesiologist to come to deal with them in time. A competent nurse anesthetist who can handle even most situations. In this way, the excessive work intensity caused by the shortage of anesthesiologists is greatly alleviated.
More importantly, such an arrangement can realize the monitoring and nursing of the whole cycle during labor analgesia, which can ensure the safety of the mother.
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