Why mothers don't walk : An audit of mobilty in labour with patient controlled epidural analgesia
Abstract Number: S-38
Abstract Type: Original Research
Introduction: Maternal mobility in labour with low dose central neuraxial blockade has been found to between 37% and 58% from previous studies(1,2). The method for administering low dose mixture (LDM) has moved from midwife administered to patient controlled epidural analgesia (PCEA). Following the introduction of PCEA on our unit and concerns raised regarding reduced mobility of parturients, we conducted an audit to investigate why mothers did not mobilise.
Methods: After discussion with our ethics department, data was collected prospectively over a one month period from parturients who received PCEA for labour. Reasons for not mobilising were recorded. Parturients and midwives attitude towards mobilising were noted. Other data collected included: duration of labour post PCEA, total volume of LDM used, factors affecting ability to mobilise (intravenous infusions, catheterisation, monitoring), method of initiation of analgesia (combined spinal epidural [CSE] or epidural) and mobility pre and post PCEA (the highest modified Bromage score achieved and extent of mobility).
Results: Complete data was collected on 59 mothers. Patient demographic data were similar. 55 (93%) did not mobilise out of bed at any point in labour after receiving PCEA. Reasons given by mothers for not mobilising after PCEA included tiredness in 16 of 55 (29%), feeling unsafe in 15 (27%), being attached to monitoring in 14 (26%), no time to mobilise in 6 (11%) and some were actively discouraged 4 (7%). 62% of parturients would have wanted to mobilise during their labour but less than half (45%) felt they were encouraged to do so. All patients receiving a PCEA were catheterised, cannulated and attached to CTG monitoring. There was no difference in total LDM used or duration of PCEA in labour between those that mobilised and those that did not.
Conclusion: Our parturients with PCEA during labour mobilised significantly less than in previous studies despite the fact that the majority had minimal motor block and would have wanted to mobilise. Portable PCEA pumps, telemetric CTG monitoring and avoiding urinary catheterisation where possible may improve mobility.
References: 1. Price C, Lafreniere L, Brosnan C, Finley I . Regional analgesia in
early active labour: combined spinal epidural vs epidural.Anaesthesia 1998;53:951–5
2. COMET study group. Effect of low dose mobile versus traditional epidural techniques on mode of mobility: a randomised controlled trial. The Lancet 2001; 358; 19-23