Podium Presentation: Continuous Labor Epidural Placement Trends among Parturients: An Evidence-Based Practice Project

Background: Childbirth is very painful, and unmanaged pain may reduce patient satisfaction or lead to other complications. Evidence indicates that pain severity is lower among parturient women administered analgesia via a continuous labor epidural (CLE) and that maternal request is sufficient indication for CLE placement to manage labor pain. In some cases, a medical induction of labor may be scheduled, offering an opportunity for proactive pain management from hospital staff. Yet, trends on timing of CLE placement among parturient women with scheduled labor induction versus spontaneous labor in hospitals in Eastern Washington at one health system are unclear. Purpose: The purpose of this project was to describe CLE placement trends over time among parturient women scheduled for labor induction versus spontaneous labor onset in two Eastern Washington hospitals. Methods/Approach: A retrospective, observational, evidence-based project was conducted to describe factors involved in CLE placement among women with scheduled versus spontaneous labor. The team’s data scientist performed a data extraction to characterize all non-scheduled cesarean delivery encounters for labor with a live birth between January 2014 and December 2020. Extracted variables included demographics (age, body mass index, gravida, parity, amniotomy), hospital characteristics (induction status, year of admission) and CLE characteristics (CLE placement status, time-to-CLE placement from admission time). Records were excluded for occurrence of fetal demise on delivery. Results were analyzed in Excel using descriptive statistics, t-tests for continuous variables, and chi-square for categorical variables. A p-value of 0.01 was selected for significance. Results: Nearly 20,000 hospital records met the criteria. Of these, n=5767 were scheduled for a labor induction. Overall, 12,333 patients (61%) received a CLE, on par with nationally reported rates. CLEs were placed more commonly among parturients with labor induction (87%) versus those with spontaneous onset of labor (52%, p\u3c0.001) as well as among primiparous women compared to multiparous (p\u3c0.001). CLE’s were more frequently placed over time, with the largest increase noted between 2014 and 2016. Women with labor induction were more likely to receive an amniotomy (p\u3c0.001). Time to placement comparisons revealed that patients presenting in spontaneous labor received an epidural significantly sooner than those scheduled for labor induction (median 4.6 hours vs 8.6 hours, p\u3c0.001). Conclusion: This project informs that across two hospitals in Eastern Washington, CLEs are placed at similar rates to national reports. Pain management during childbirth that includes CLE aligns with best evidence, and future work should aim to ensure that parturient women who request this intervention can receive it in a timely fashion. Implications for practice: As nurses, we strive to alleviate suffering and provide excellent care. Information from this project can be used to inform best practices for scheduling labor induction cases as well as anesthesia providers to better anticipate the timing of labor epidural needs. Information from this project would help providers tailor pain management plans with equity to parturient women in these hospitals