Running Head: THE IMPACT OF FACTORS ON EPIDURAL

The Impact of Lifestyle Factors, Demographics, and Preconceptions on the Effectiveness of

Epidurals Administered During Labor

by

Allyson Pinson

Marley Robison

A Senior Thesis Submitted in Partial Fulfillment

of the Requirements for Graduation

Central Magnet School

April 2018

Thesis Committee:

Dr. David McKnight, M.D

Mrs. Eve Harrison

Mrs. Laura Roland

Dr. Melanie Thomas

Mr. Adam Brooks

Mrs. Haley Cook

THE IMPACT OF FACTORS ON EPIDURAL ii

ACKNOWLEDGMENTS

First, we would like to thank our incredible mentor, Dr. McKnight, for helping us

throughout the entire thesis process, from choosing our topic to the finishing touches. We would

especially like to thank him for his assistance in formatting and distributing our surveys; without

him, our thesis would not have been possible. In addition, we would like to thank St. Thomas

Rutherford Hospital for allowing us to have a meeting place, as well as a professional

environment to distribute our surveys. We would like to thank the head of nurses in labor and

delivery, Dr. Angelique Dooley, RNC, and her staff for agreeing to aid in our thesis.

We would also like to thank all of our teachers- Mrs. Harrison, Dr. Thomas, and Mrs.

Roland- for helping to format and revise our thesis over the past year. Mrs. Harrison, our STEM

IV teacher, has been with us since our junior year of high school. Now in our senior year, she has

been a tremendous help with our surveys, formatting, and content. We would also like to thank

Dr. Thomas for her constant help and advice. Without her expertise, our layout would not be

nearly as organized. Thankfully, she was always available to read and revise. Next, we want to

thank Mrs. Roland for revising our paper throughout the year. She has helped us to fix countless

careless errors and aided in making our thesis the best it can be.

Additionally, we would like to thank our advisors: Mr. Brooks and Mrs. Cook. They have

been with us for the past four years, helping to guide us through high school and prepare us for

our future. They helped us to stay on track with deadlines and made sure we had every resource

necessary as we have gone through our thesis process.

Finally, we would like to thank every woman who was generous enough to take the time

to fill out our survey, as well as everyone who helped throughout the entire process.

THE IMPACT OF FACTORS ON EPIDURAL iii

TABLE OF CONTENTS

Acknowledgements………………………………………………………………………………ii

Abstract…………………………………………………………………………….……………iv

Introduction…………………………………………..…………………………………..……1-7

Research Question……………………………………………………………...…………………1

Research Purpose………………………………………………………………………………..1-2

Background Information………….……………………………………………………….….…2-6

General factors……………………………………………..……………………………3-4

Ultrasound measurement technique.....................................................................................4

BMI……………………………………………………………………………………..4-5

Epidural failure in other procedures....................................................................................5

Lifestyle factors’ impacts on pregnancy………………………………………………..5-6

Hypothesis…………………………………………………………..………………..…6-7

Methodology………………………………..…………………………………………..………8-9

Participants……………….…………………………………………………..……………8

indenttProcedure………………………………………………………………………………..8-9

Results…………………………………………………………..……………………………10-11

Discussion……………………………………………..………..……………………………12-14

indenttLimitations………….……………………………………………………………………14

Conclusion………………………..…………………………………………………….…….…15

Appendix A……………………………………………………………..……………………16-18

Appendix B…………………………………………………………………………..………19-21

THE IMPACT OF FACTORS ON EPIDURAL iv

Appendix C………………….……………………………………………………………….22-25

References………………………………………………………………..…………….……26-27

THE IMPACT OF FACTORS ON EPIDURAL v

ABSTRACT

The purpose of this research is to observe the effects of specific habits, preconceptions,

demographics, and conditions on the outcome of epidurals during labor and delivery. Based on

prior research, it is known that certain lifestyle factors and techniques have an impact on the

effectiveness of epidurals, so this research seeks to make new connections. With the

administration of three surveys, it was expected that results would show trends that negative

connotations and unhealthy habits would lead to ineffective epidurals and more side effects. The

survey to the public shows that although 54% of participants had a positive connotation of

epidurals, 51% had complications. A few main factors had a high correlation with side effects

and failures, such as anxiety and depression. In a variety of cases, failures occurred as the result

of human error. By taking more precautionary measures and ensuring accuracy during

administration, the percentage of failed epidurals- along with epidural complications- can be

reduced.

THE IMPACT OF FACTORS ON EPIDURAL !1

INTRODUCTION

Research Question

Do lifestyle factors, as well as demographics and preconceived notions, have an impact

on the overall effectiveness of an epidural administered during child labor?

Research Purpose

This study sought to explore the impact of lifestyle choices and demographics on the

effectiveness of epidural anesthesia during labor and delivery through the administration of three

surveys: pre-delivery, post-delivery, and open to the public. Some of the key factors we planned

to consider before delivery included body mass index, unhealthy living habits, history of disease,

age, and ethnicity. Likewise, we also considered and observed the impact of current medications

in use, complications during pregnancy, and the number of previous births prior to the epidural

administration. In addition, we planned to uncover the strength of each factor as a determinant.

Unbeknown to the participants, the experiment also focused on patients’ expectations concerning

pain control during labor and delivery, and how these expectations affect patients’ pain

management choices, and in turn, the epidural’s outcome. Epidurals can fail in a multitude of

ways and have multiple side effects. These failures include the following: only working for

certain areas, complete failure, and the necessity to be re-administered (Hermanides, Hollmann,

Stevens, & Lirk, 2012). The most common side effects we planned to discern were hypertension,

hypotension, spinal headache, maternal fever, spinal pain, facial flushing, anxiety, sleeplessness,

neck stiffness, dural puncture, bleeding, bruising, nausea, itching skin, loss of bladder control,

and difficulty breathing (Staehler, 2017). If demographics and lifestyle choices impact the
THE IMPACT OF FACTORS ON EPIDURAL !2

effectiveness of epidural anesthesia during child labor, expectant moms should be warned prior

to labor and coached through the necessary habits for a more seamless delivery.

Background Information

There are a multitude of pain management techniques utilized during labor; these

techniques include narcotics, spinal block, and epidural. Typically administered in child birth,

epidural anesthetic is an injection of a local anesthetic into the space outside the dura mater- the

tough outermost membrane of the brain and spinal cord in the lower back region- to produce loss

of sensation, especially in the abdomen or pelvic region. While an epidural is the most common

type, it can easily fail. Arendt and Segal (2017) qualify a failure as when the “catheter is not sited

within the epidural space correctly, the patient’s neuraxial anatomy is problematic, or a patient’s

labor progresses more quickly than expected by the anesthesiologist, and the epidural block does

not set up on time.” More plainly, these failures include the following: insufficient analgesia,

temporary paralysis, and dislodgment (Hermanides et al., 2012). In this case, insufficient

analgesia qualifies as both complete failure and failure only in certain areas. Additionally,

dislodgment requires the necessity to be re-administered. Arendt and Segal (2017) cited the study

that claimed, “the most comprehensive review of obstetric neuraxial failures is a retrospective

analysis of 19,259 deliveries that demonstrated an overall failure rate of 12%."

In addition to failures, there are many possible side effects. The most common side

effects of an epidural are hypertension, hypotension, spinal headache, maternal fever, spinal pain,

facial flushing, anxiety, sleeplessness, neck stiffness, dural puncture, bleeding, bruising, nausea,

itching skin, loss of bladder control, and difficulty breathing (Staehler, 2017). A common theme
THE IMPACT OF FACTORS ON EPIDURAL !3

evident throughout our research was that epidural failure and epidural side effects can be traced

back to a series of lifestyle choices, as well as demographics.

Epidural analgesia is known to be the most effective method of pain management during

child labor. While it is so commonly used, it has many drawbacks that mothers have to consider

before committing to the procedure. To reiterate, these downsides include things such as

hypotension, headaches, and dural puncture. Additionally— although only in very rare

occurrences— permanent morbidity and mortality have also been observed as negative results of

an epidural.

Researchers concluded that the overall downfalls that warrant consideration regarding the

topic of epidural versus no epidural include the following: more operative intervention, longer

labor process, and an increase in cost (Avard & Nimrod, 1985). One study was performed to

observe risk factors for failed epidural analgesia and to study postpartum effects after failure. Of

the 414 women who participated, 8.5% experienced a failed epidural analgesia (Bucstain et al.,

2017). Knowledge of the risk of failure rate, risk factors, and the post-delivery effects of failed

epidural analgesia could potentially improve mothers’ awareness and labor management choices.

General factors

In the past, researchers determined a correlation between the presence of an epidural

administration and maternal fever during labor. Additionally, after observing oxytocin use,

seniority of the anesthesiologist, and fetal head station, researchers concluded that both higher

fetal head station and oxytocin- a drug used to stimulate labor- use may correlate with high

failure rates. On the other hand, outcomes after delivery did not correlate with second-stage
THE IMPACT OF FACTORS ON EPIDURAL !4

duration and operative vaginal delivery rate and success or failure rate of the epidural (Bucstain,

2017).

Ultrasound measurement technique

A different study was performed to observe whether or not ultrasound measurement of

depth from skin to epidural space before the epidural technique could decrease the rate of failed

epidural analgesia before labor. According to the results, the ultrasound group had fewer failed

epidural replacements and placement attempts than the control group (Vallejo, Phelps, Singh,

Orebaugh, & Sah, 2010). Upon conclusion, researchers determined the ultrasound measurement

of the epidural space depth before epidural placement technique before delivery does, in fact,

decrease the need for epidural catheter replacement after a failed labor analgesia in labor. At the

same time, the measurement also reduces the number of attempts of epidural administration by

first year residents— a topic often studied.

BMI

One recurring lifestyle factor that has a tendency to increase the epidural failure rate is

body mass index (BMI), and thus, obesity. In a study that took place at an inner-city teaching

hospital, 2,048 women who were set to receive an epidural for labor were observed. This study

was conducted in the hopes of finding a link between the increasing of body mass index as

related to epidural failure and difficulty. It was discovered that, in most cases, patients with a

higher body mass index were more likely to experience epidural failure and difficulty (Kula,

Riess, & Ellinas, 2017). There were also apparent correlations with higher body mass index and

prolonged discovery of epidural failure. This experiment demonstrated the relationship between

obesity and issues related to epidurals, as well as served as an advisory for practitioners to plan
THE IMPACT OF FACTORS ON EPIDURAL !5

to spend extra time whilst dealing with a patient who has a high body mass index that is

receiving an epidural.

Epidural failure in other procedures

As previously stated, although epidurals are commonly performed, there is a perceived

high failure rate. Epidurals are performed in a multitude of surgeries, not solely labor and

delivery. In addition to studies focused on labor, research has been performed regarding epidurals

in other procedures. One study was directed at the debate regarding how often the procedure

should be performed for credibility to be maintained. Prior to the study, researchers hypothesized

that an increase in procedure frequency would have a positive correlation with the success of the

procedure. While not focused on labor, this study was conducted on patients undergoing intra-

abdominal as well as thoracoabdominal surgery who received epidural analgesia post-operation.

After a total of 881 epidurals preformed over the course of the study, it was concluded that there

were no obvious correlations between procedure frequency and success rate; however, parallels

could be drawn between the success of epidurals and institutional factors such as the experience

of the practitioner (Heinink, Baker, Yates, Addison, & Williams, 2015).

Lifestyle factors' impact on pregnancy

Factors such as permanency of physicians, body mass index, fetal head station,

ultrasounds, and oxytocin use have already been scientifically proven to have an impact on the

effectiveness, or lack thereof, of an epidural during both fetal delivery and miscellaneous

surgeries. Although studies have not yet been done regarding life style factors such as drinking,

smoking, and medication usage, studies and their effect on epidurals, the effects of these factors

on pregnancy have been observed.

THE IMPACT OF FACTORS ON EPIDURAL !6

Approximately 10% of women reported smoking during the last 3 months of pregnancy.

Of women who smoked 3 months before pregnancy, 55% quit during pregnancy. Among

women who quit smoking during pregnancy, 40% started smoking again within 6 months

after delivery (Centers for Disease Control, 2017).

Smoking during pregnancy can inflict: a higher chance for miscarriage, placenta

problems, low birth weight, prematurity, Sudden Infant Death Syndrome, and birth defects

(Centers for Disease Control, 2017). In addition, drinking during pregnancy has proven to have

many side effects.

Drinking alcohol during pregnancy can cause miscarriage, stillbirth, and a range of

lifelong physical, behavioral, and intellectual disabilities. These disabilities are known as

fetal alcohol spectrum disorders (Centers for Disease Control, 2017).

The effects of drug usage during pregnancy have also been observed and were proven to be

similar to those of smoking and drinking.

More than 50% of pregnant women take prescription or nonprescription (over-the-

counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some

time during pregnancy, and use of drugs during pregnancy is increasing. About 2 to 3%

of all birth defects result from drugs that are taken to treat a disorder or symptom (Merek

Manual Consumer Version, 2017).

Hypothesis

Based on the research above, many factors contribute to failed epidural analgesia. The

impact on epidural success in relation to factors we studied, such as history of disease, age, race,

ethnicity, and patients’ expectations concerning pain control during labor and delivery and how it
THE IMPACT OF FACTORS ON EPIDURAL !7

affects their pain management choices had not previously been determined. Lifestyle factors,

demographics, and preconceived notions have an impact on the overall effectiveness of an

epidural administered during child labor. We hoped to prove unhealthy habits and negative

preconceived notions lead to a less effective epidural administration.

THE IMPACT OF FACTORS ON EPIDURAL !8

METHODOLOGY

Participants

Our study was partially conducted at St. Thomas Rutherford Hospital in Murfreesboro,

Tennessee and consisted of women in labor. Each expectant woman who entered the hospital

during the duration of our study was asked by their nurse to participate, and if they agreed, they

were given a pre-delivery survey to fill out. Every woman entering labor and delivery was

requested to participate, and surveys regarding all methods of pain management were collected;

however, data was only used from those who received an epidural as their method of pain

management. Data was collected in order to observe the correlation between both age and

ethnicity factors. Any given woman could come across the survey, as each nurse of Dr.

McKnight offered it to every patient. Since being a woman who had received an epidural in the

past was the only criteria, women from all age groups, ethnicities, and socioeconomic levels

were involved.

To expand upon this, our second group of participants consisted of any woman who had

received an epidural in the past and was willing to participate in our study. These women were

randomly selected, as anyone who came across the survey- via social media, word of mouth, or

otherwise- was invited to participate.

Procedure

In order to determine the impact of lifestyle factors and demographics on the

effectiveness of epidurals during childbirth, we administered three surveys. The first survey was

administered to pregnant women immediately prior to labor. The second was filled out by the

same women prior to discharge. In order to distribute the surveys, each nurse handed the patient
THE IMPACT OF FACTORS ON EPIDURAL !9

a paper composed of an explanation and a request to participate. If the patient agreed to

participate, the pre-delivery survey was handed out by paper copy, each containing a unique

number. The pre-delivery survey contained demographic questions including: age range, BMI,

medical history, complications during surgery, knowledge about epidurals, and details regarding

previous births. This survey can be found in Appendix A. The post-delivery survey, in Appendix

B, was administered online and linked to the first by filling out the corresponding number. The

post-delivery survey contained questions including complications during delivery, method of

delivery, method of pain management, the length of delivery, and if applicable, how far along the

patient was when she received the epidural and post-epidural side effects. During the first and

second surveys, a nurse who was aware of the research process was present to help and answer

any questions regarding the survey. The nurse also filled out the BMI for each patient on the pre-

delivery survey, as it was located on their chart.

The third survey was administered through word of mouth, social media, and email. We

asked parents, teachers, and friends to distribute the survey in any way they could. It was

distributed to as many people as possible, yet only answered by women who had an epidural in

the past. It was intended to gain more results, as well as to observe patterns. Questions included

age when the participant gave birth, methods of delivery, complications with pregnancy,

complications with the epidural, number of births, the length of the delivery process, et cetera.

This survey can be located in Appendix C.

THE IMPACT OF FACTORS ON EPIDURAL !10

RESULTS

Figure 1: Connotation of Epidurals

35%

54%

11%

Figure 2: Presence of Epidural Complications

No Complications Complications

49% 51%
THE IMPACT OF FACTORS ON EPIDURAL !11

Nearly 11% of participants who experienced complications had an experience with an

ineffective epidural. An ineffective epidural was categorized as not “taking” completely, not

“taking” at all, or not working in time. Additionally, nearly 17% of the participants who

experienced complications experienced slowed labor. The additional 21% with complications

experienced one or more of the side effects in the following graph.

Figure 3: Side Effects Experienced Within 24 Hours

THE IMPACT OF FACTORS ON EPIDURAL !12

DISCUSSION

Some of the most prominent complications we found from our study were epidurals

resulting in the slowed progression of labor and epidurals being ineffective as a pain treatment

intervention. While the majority of participants indicated that they had either a positive

connotation of epidurals or didn’t have any connotation at all, we did notice nearly all of the

participants who selected that they had a “negative connotation” of epidurals pre-delivery

experienced some form of epidural failure. This being said, we suspect that people who chose to

respond to our survey may have done so because of their suboptimal experience. People who are

happy with their results don’t have an ax to grind, and thus, may be less likely to respond to a

survey such as this. For example, one woman pushed for three hours and still has urinary

incontinence twelve years later. She blames the epidural for this issue; however, her urinary

incontinence is probably “stress urinary incontinence,” which virtually every woman who has

had a vaginal birth experiences to some degree. This complication is not related to her epidural,

but it does go along with our suspicion that women who are less satisfied with their epidural

might be more likely to complete the survey.

We found that patients with a past or present history of anxiety and/or depression were

more apt to experience slowed progression. In addition, we found that women who reportedly

had a history of smoking and/or drinking experienced a multitude of epidural failures including,

but not limited to, slowed labor and/or ineffectiveness of epidural. In one case of smoking and

drinking abuse, a woman experienced temporary paralysis for a day and half and extreme

soreness for the next three months.

THE IMPACT OF FACTORS ON EPIDURAL !13

Nearly half of our participants selected one or more side effect(s) that they experienced

within twenty-four hours of receiving their epidural. Some of the most present side effects we

saw were the following: nausea (27%), itching skin (24.2%), spinal headache (20.7%), and fetal

distress (16.4%).

Multiple women experienced epidurals that did not “take,” requiring repetitions of

administration or feeling the entire delivery, as well as epidurals only taking on one side. Often

times, the epidural caused the inability to push, which in turn, resulted in the necessity for

delivery by forceps or vacuum. Further, we noticed a few unusual failures of epidurals. One

woman explained that she experienced a bad epidural, wherein the epidural went to her brain

instead of legs. This participant had a multitude of factors that we looked into including:

diabetes, older age, history of hypertension, and preeclampsia. Another woman shook

uncontrollably after the epidural wore off. On the other hand, one participant’s epidural wore off

before the baby was delivered, but it was too late to administer again.

Human error also played a role in some of the epidural failures in the instances of incorrect

administration. One woman’s epidural was administered incorrectly, resulting in complete

numbness from the neck down. Another woman’s epidural was done upside down, wherein she

could not feel anything above her legs, but felt everything in her lower body. Additionally, many

of our participants reported misplacement during the administration of their epidurals, resulting

in additional side effects and partial or complete epidural ineffectiveness.

We did not find any significant correlations between ethnicity and effectiveness of

epidural, as 95.7% of our 529 participants were of European descent. Likewise, we also did not

find strong evidence of any medications affecting the epidural.

THE IMPACT OF FACTORS ON EPIDURAL !14

Limitations

One major limitation we faced was the lack of surveys received back from the hospital, so

we did not gather results from either survey A or B. We were able to compensate for this loss

with the numerous responses we received back from our survey open to the public; however, had

we gotten back more responses from our survey administered from the hospital, we would have

been able to have more current, precise results.

THE IMPACT OF FACTORS ON EPIDURAL !15

CONCLUSION

Of the many pain management techniques used during labor, epidurals are the most

commonly used. While many women experienced epidural side effects and failures, the vast

majority of participants were very pleased with the success and pain relief of their epidurals. Any

method of pain management is bound to have complications, but an improved success rate could

improve connotations. A larger percentage of positive connotations could, in turn, lessen anxiety

and stress prior to the administration.

If this study were to be redone, it would require more time, as to increase participants. A

larger participation in the hospital surveys would allow for more significant results and more

obvious patterns. More participants in the hospital surveys would have allowed for enough

results to be used; these results are desirable, as they would be more current and exact.

There was, if fact, an impact of lifestyle factors and preconceptions on the effectiveness of

epidurals during labor. Women with negative connotations and unhealthy habits had a lower

success rate with more side effects and complications. Moms who are expecting should be

warned of the side effects and complications prior to labor and delivery and informed of the best

lifestyle habits for an easier delivery.

THE IMPACT OF FACTORS ON EPIDURAL !16

APPENDIX A

The Effects of Pain Relief Techniques on Childbirth

1. Age Range: (Circle one) 


1. 18 and under


2. 19-22


3. 23-26


4. 27-30


5. 31-34


6. 35-40


7. 41-45


8. 46+


2. What was your expectation when considering your first epidural?


1. Complete pain relief


2. Moderate pain relief


3. Not much pain relief


4. The likelihood of side effects outweighed the expected benefits


3. Is there any past or present history of: (Circle all that apply) 


1. Anxiety 


2. Asthma


3. Cancer


4. Depression 

THE IMPACT OF FACTORS ON EPIDURAL !17

5. Diabetes


6. Drinking


7. Drug Use


8. Epilepsy


9. Headaches 


10. Heart Disease


11. Hypertension


12. Hypotension


13. Migraines 


14. Smoking


4. Ethnicity: (Circle all that apply)


1. European descent 


2. African descent 


3. Hispanic descent


4. Hawaiian/ Pacific Islander


5. Middle Eastern descent


6. Asian descent


7. Other


5. BMI: (To be filled out by nurse)


6. Any complications of pregnancy:


THE IMPACT OF FACTORS ON EPIDURAL !18

7. Current medications in use:


8. Has a family member or close friend used epidural anesthesia for childbirth?


1. If Yes, was their experience positive or negative? If No, continue on to number 9.


9. Number of previous births:


1. If one or more, what were your previous methods of delivery? If none, the
survey is complete.


2. Previous methods of pain management?


3. Previous complications:

THE IMPACT OF FACTORS ON EPIDURAL !19

APPENDIX B

Post-Delivery Survey

* Required

Survey Number *

Your answer:

Method of Delivery *

Vaginal Birth

Cesarian Section

Were there any complications with labor? *

Your answer

Please select any of the following that you experienced within 24 hours of receiving your method

of pain management. *

Hypertension (abnormally high blood pressure)

Hypotension (abnormally low blood pressure)

Spinal Headache

Maternal Fever

Spinal Pain

Facial Flushing

Anxiety
THE IMPACT OF FACTORS ON EPIDURAL !20

High Blood Sugar

Low Blood Sugar

Dural Puncture ("wet tap")

Bleeding

Bruising

Nausea

Itching Skin

Loss of Bladder Control

Difficulty Breathing

Fetal Distress

Sleeplessness

When considering your first epidural, what was your expectation? *

Complete pain relief

Moderate pain relief

Not much pain relief

The likelihood of side effects outweighed the expected benefits

Prior to childbirth what was your connotation of epidurals?

Positive

Negative

Neither
THE IMPACT OF FACTORS ON EPIDURAL !21

Does requesting an epidural reflect a failure as a new mother to any extent?

Your answer:

Method of Pain Management *

Natural Birth

Epidural

Narcotics

Spinal Block

Other

If epidural, please answer the following:

How far along were you when the epidural was administered? (Answer in centimeters of

dilation.)

Your answer:

Were there any complications with the epidural?

Your answer:

Length of delivery process once the epidural was administered

Your answer:

THE IMPACT OF FACTORS ON EPIDURAL !22

APPENDIX C

Effectiveness of Past Epidurals

Our names are Ally Pinson and Marley Robison, and we are seniors at Central Magnet School.
As a partial fulfillment of the requirements for graduation, we are completing a senior thesis. If
you are a woman who has had an epidural in the past, we would really appreciate it if you could
fill out our anonymous survey. Thank you!

* Required

Ethnicity *

African descent

Asian descent

European descent

Hawaiian/ Pacific Islander

Hispanic descent

Middle Eastern descent

Other:

Number of births *

Your answer:

Method of deliveries: *

Vaginal birth

Cesarian Section

Both
THE IMPACT OF FACTORS ON EPIDURAL !23

How many times did you receive an epidural? *

Your answer:

What age(s) were you when you received your epidural(s)? *

Your answer:

At the time of your epidural, was there any past or present history of: *

Anxiety

Asthma

Cancer

Depression

Diabetes

Drinking

Drug Use

Epilepsy

Headaches

Heart Disease

Hypertension

Hypotension

Migraines

Smoking
THE IMPACT OF FACTORS ON EPIDURAL !24

None of the above

Please select any of the following that you experienced within 24 hours of receiving your

epidural.*

Hypertension (abnormally high blood pressure)

Hypotension (abnormally low blood pressure)

Spinal headache

Maternal fever

Spinal Pain

Facial flushing

Anxiety

Sleeplessness

High blood sugar

Low blood sugar

Dural Puncture ("wet tap")

Bleeding

Bruising

Nausea

Itching Skin

Loss of bladder control

Difficulty breathing

Fetal distress
THE IMPACT OF FACTORS ON EPIDURAL !25

Were you taking any medications at the time of epidural? (List if possible) *

Your answer:

Did you have a positive or negative connotation of epidurals before you had your first? *

Positive

Negative

Neither

Any complications with labor after epidural: *

Your answer:

Any complications with pregnancy: *

Your answer:
THE IMPACT OF FACTORS ON EPIDURAL !26

REFERENCES

Arendt, K., MD, & Segal, S., MD. (2008). Why Epidurals Do Not Always Work. Retrieved

September 27, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505163/

Avard, D. M., & Nimrod, C. M. (1985). Risks and benefits of obstetric epidural analgesia: a

review. Birth (Berkeley, Calif.), 12(4), 215-225.

Bucstain, C., Garmi, G., Zafran, N., Zuarez-Easton, S., Carmeli, J., & Salim, R. (2017). Risk

factors and peripartum outcomes of failed epidural: a prospective cohort study. Archives

Of Gynecology And Obstetrics, (5), 1119. doi:10.1007/s00404-017-4337-5

Drug Use During Pregnancy - Women's Health Issues. (2017). Retrieved September 28, 2017,

from http://www.merckmanuals.com/home/women-s-health-issues/drug-use-during-

pregnancy/drug-use-during-pregnancy

Fetal Alcohol Spectrum Disorders (FASDs). (2016, July 21). Retrieved September 28, 2017,

from https://www.cdc.gov/ncbddd/fasd/alcohol-use.html

Heinink, T. P., Baker, B. G., Yates, V. F., Addison, D. C., & Williams, J. P. (2015). The effect of

anaesthetist grade and frequency of insertion on epidural failure: a service evaluation in a

United Kingdom teaching hospital. BMC Anesthesiology, 155. doi:

10.1186/1471-2253-15-5

Hermanides, J., Hollmann, M. W., Stevens, M. F., & Lirk, P. (2012). Failed epidural: causes and

management | BJA: British Journal of Anaesthesia | Oxford Academic. Retrieved

September 27, 2017, from https://academic.oup.com/bja/article/109/2/144/253749/Failed-

epidural-causes-and-management
THE IMPACT OF FACTORS ON EPIDURAL !27

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