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What is the SOP for administering epidural for labour in SG?

Gynaecology Pregnancy

My sister was in labour for 19 hours.

At 10th hour she asked for epidural. At the 18th hour the doctor was informed by nurse that my sister had epidural already. In fact she had 2 dosages of it.

The doctor rushed in after the nurse and exclaimed “I didn’t know you had epidural, or else I will put that IV bag sooner to hasten the labour!”

The hospital said its not a standard procedure for nurses to inform doctor when epidural starts (at 12 noon and doctor only knew at 7.30pm).

I would like to know what’s the acceptable standard for epidural administration and notification.

The baby was later vacuumed out within 30 minutes due to increased heart rate and lack of oxygen (waterbag broke at 2am in the early morning earlier). Could this be due to the prolonged labour?

DOCTOR’S ANSWER (1)

It is not possible to comment accurately on your sister’s labour as we will not be privy to the exact circumstances of what happened.

In general though, the nurses in all labour wards will help the patient arrange for pain relief if it is required, whether it is in the form of epidural, entonox gas or painkiller injections.

All nurses in labour wards are also highly trained to assess patients in labour and their progress (degree of dilation and descent down the birth canal).

Generally the obstetrician is well aware of the progress of the patient as well, as well as whether she had an epidural placed, via regular checks in person and/or communications with nurses. 

Vacuum assisted delivery is not uncommon because of an abnormal fetal heart rate trace at the end, and this can be due to a variety of reasons, prolonged labour being one of them.

It can very well also occur because of the umbilical cord or head compression at the end stage of labour.

The length of labour is variable among individual women, and factors that affect these include:

  1. Whether the labour was induced
  2. Strength and frequency of contractions
  3. Whether mum is a first time mum (most significant factor that affects length of labour)
  4. Size of baby
  5. Position of baby in birth canal (occiput anterior position or otherwise e.g. asynclitic head, persistent occiput posterior position).
646 views 26 Jan 2018
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