Legal and medical safety issues of epidural analgesia for labor. Experience in Vinnytsia region
Labor analgesia is an important aspect of the childbirth, which significantly affects the process, quality, outcome and cost of childbirth. Epidural analgesia provides the most effective relief of labor pain in comparison with other methods of anesthesia. According to the recommendations of the WHO and the most of the world’s leading organizations, the request of a pregnant woman is a sufficient medical indication for the pain relief during labor (level C). The risk of complications during labor is low — about 1 in every 80,000 births. Some of them are directly related to anaestetics or with the technique of execution. Others, such as chronic back pain and cesarean section, are the effects of the neuroaxial block, but not caused by the technique of epidural analgesia. Finally, the cause of some complications, such as fever and breast-feeding, remains unclear. The use of innovative drug combinations and the change in the approaches to intrapartum obstetrical care have led to an increase in the safety profile of epidural analgesia. A reserve for improving the delivery of services in the context of epidural analgesia and increasing the safety of obstetric patients is an active approach to risk management. This article represents the experience in Vinnytsia region in informing patients, measures to ensure the optimal management and documentation of childbirth in the context of epidural anesthesia, using information and communication tools developed and implemented in the clinical practice. Informing the patient about the provision of anesthetic care is one of the elements of the modern system of legal regulation of the medical service sector, the main components of which are: clarification of the essence of the chosen method of anesthesia, discussion of the benefits and risks associated with this method, as well as its influence on the course of labor, the existing alternatives to the proposed method of anesthesia. For information and discussion, anesthetists from Vinnytsia region use the newsletter “Epidural analgesia and childbirth”. This is a fact of receiving from an anesthetist doctor complete objective and comprehensive information about the essence of the future method of pain relief. All explanations regarding anesthetic provision of deliveries provided by the anesthetist are clearly documented in the informed voluntary consent of the patient for anesthesia during labor/cesarean section. An anesthesiologist and/or nurse-anesthetist who are responsible for taking notes of the course of events play a crucial role in monitoring the condition of a woman after delivery. The form developed and introduced by us in the clinical practice in Vinnytsia region is a checklist of medical prescriptions, basic physiological indicators of maternal and fetal control, and reflects their changes at the monitoring stage.
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