Minnesota Nursing magazine
Improving outcomes with epidural anesthesia
Samantha A. Sommerness,
DNP, APRN, CNM
While Clinical Assistant Professor Samantha A. Sommerness, DNP, APRN, CNM, was a Doctor of Nursing Practice student at the School of Nursing, she helped set safety standards with a team at Fairview Health Services.
As part of her quality improvement project, she modified and implemented a guideline for second stage labor for women who chose epidural anesthesia for pain management.
The 403 records of women giving birth during a three-month period prior to guideline implementation were compared with those of 429 women after the guideline was adopted. The post-guideline implementation group had lower odds of vacuum-assisted births than the pre-guideline implementation group. The difference in median length of the second stage, Apgar, episiotomy, third-degree laceration or cesarean birth rates were not found to be statistically significantly different. However, active median pushing time was significantly shorter (31 minutes) post-guideline compared to preguideline implementation (39 minutes), and it was even shorter with documented adherence to the guideline (25 minutes).
Among the 429 women in the post-guideline group, 51 percent delayed pushing compared with 6 percent in the pre-guideline group. Use of the guideline was documented for 58 percent of women, of whom 78 percent delayed pushing. Using a specific guideline for delayed pushing may improve outcomes and provide a model others may use to standardize care during second stage labor for women with epidural anesthesia.
The study findings were recently published in the April issue of Research on Womens Health and the January/March 2017 issue of Journal of Perinatal and Neonatal Nurses.
Center for Child and Family Health Promotion Research
Jayne Fulkerson, PhD
To improve the health of infants, children, adolescents, parents, and families in the context of their communities. Center members develop and disseminate evidence-based interventions and best practices in primary and secondary prevention.
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