Shared learning database
Type and Title of Submission
Labour analgesia clinical auditDescription:
A clinical audit of the provision analgesia in labour and women's satisfaction with the analgesia they received. Authors: Dr.Indrani Wijesurendra, Dr. Surendhren Moodliar, Dr.Imran Sharieff, Dr.Sudath Kumarasinghe, Dr.Sara Ameen.Does the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG55 - Intrapartum careIs the submission industry-sponsored in any way?
Description of submission
Aims and objectives
To look at the quality of labour analgesia for patients in Labour Ward at Queen Elizabeth Hospital.Context
The pain of child birth is arguably the most severe pain endured by most women within their lifetimes. Today, there is an array of regional techniques, systemic analgesics and non-pharmacological techniques available to labouring mothers. It is now accepted that it is a basic humanitarian right to provide women with appropriate pain relief in labour, if wished for. The NICE 2007 intrapartum care guidelines suggest that women who choose non-pharmaceutical options should be supported, entonox should be available to all women and women should not be denied epidurals, even if in latent labour. Other published audits/studies have shown that reported maternal satisfaction is often high. Our primary proposed standard was a satisfaction rate of 90% or greater.Methods
The sample was 100 women on Labour Ward in any state of labour during a one week period (starting late June 2011). Women having elective caesarean sections or home births were excluded. Women were interviewed after delivery; 85% by direct interview and 15% by telephone consultation. They were asked to rate their satisfaction with their labour analgesia (satisfied, partially satisfied or not satisfied). Details of any dissatisfaction were explored and any complications from labour analgesia reported. Standard: 90% of maternal satisfaction with labour analgesia.Results and evaluation
42% of women were nullparous, 77% of women had normal vaginal deliveries, 16% had emergency Caesarean sections and 7% had instrumental deliveries. 80% had 'short' labours of 12 hours or less.
5 women could not be interviewed: 1 refused, 3 were uncontactable and there was a language barrier with 2 women. Of the remaining 95 women, 23 reported using non-pharmaceutical means of analgesia. These were:
- TENS (3 women)
- relaxation techniques (6 women)
- water bath (3 women)
- massage (4 women)
- birthing ball (4 women)
- yoga (1 woman)
- hypnobirthing (1 woman)
- gum shield (1 woman)
- unspecified breathing techniques (1 woman)
- walking (1 woman)
75 women used entonox. Pethidine was used by 26 women. Meptazinol was used by one woman. Paracetamol/codeine preparations were used by 6 women. 18 women used entonox and pethidine and 1 used entonox, pethidine and meptazinol. Epidurals were requested by 33 women but provided to only 21. Of the 33 women, 7 had a documented contraindication; in all cases the contraindication was lack of time before the second stage of labour. 57% of the women felt that their epidural was effective, 29% felt it was partially effective and 14% not effective at all. Of the total 95 patients interviewed: - 80% were satisfied - 5.3% were not satisfied - 14.7% were partially satisfied. This means that the 90% standard was not met. In the 19 women who were not satisfied with their analgesia, 17 quoted inadequate pain relief as the major reason. In some cases, women requested epidurals but didn't receive them as: - no obstetric anaesthetist was available, after which it was too late - the women felt that they were discouraged from having an epidural by their care providers - they were told they couldn't have any other pain relief after pethidine (which wasn't effective) - a woman was told that her labour would take a long time and she could have it later, however labour was rapid and there was no time
-Some of the women were seen more than 48 hours after delivery. This may have had an effect on their recollection of labour and satisfaction or dissatisfaction with their pain relief.
-Non-pharmacological pain relief techniques are not routinely recorded and so may be under-reported in this audit.
-The data only represents one week of labour ward activity. This probably reflects predominantly the work of 2-3 on call anaesthetists. The epidural data may not reflect the broader practice of our obstetric anaesthesia service.
View the supporting material
|Name:||Dr Indrani Wijesurendra|
|Job Title:||Consultant Anaesthetist|
|Organisation:||South London Healthcare NHS Trust|
|Address:||Queen Elizabeth Hospital, Stadium Road|
|Phone:||020 8836 6000|
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This page was last updated: 24 July 2012