Date Published: May 20, 2018
Author(s): Sangeeta Kumaraswami, Suryanarayana Pothula, Mario Anthony Inchiosa, Keshar Paul Kubal, Micah Alexander Burns.
Neuraxial labor analgesia has become an integral part of modern obstetric anesthetic practice. Presence of a familiar person during its placement may be beneficial to the patient. A survey was sent to anesthesiologists practicing obstetric anesthesia in the USA to determine their views.
The survey queried the following: existence of a written policy; would they allow a visitor; visitor’s view, sitting or standing; reasons to allow or not allow a visitor; and influence by other staff on the decision. The responses were analyzed using multiple chi-square analyses.
Most practitioners supported allowing a visitor during placement. Reduction of patient anxiety and fulfillment of patient request were the major reasons for allowing a visitor. Sitting position and no view of the workspace were preferred. Visitor interference and safety were cited as the major reasons for precluding a visitor. Nonanesthesia providers rarely influenced the decision. Epidural analgesia was the preferred technique. Essentially no bias was found in the responses; there was statistical uniformity regardless of procedures done per week, years in practice, professional certification, geographic region (rural, urban, or suburban), or academic, private, or government responders.
The practice of visitor presence during the placement of neuraxial labor analgesia is gaining acceptance.
Over the last few decades, there have been increased in-hospital deliveries, and they account for 99% of all deliveries . The need for psychological support of women in labor was recognized, and men were encouraged to provide support in the care of their partners during labor . Though there was some initial opposition, this practice has become common now . A pleasant birthing experience facilitates the creation of a strong bond between parents and the infant . Continuous epidural anesthesia for pain management during childbirth has become a common practice in the United States of America and the rest of the world, with a significant number of women receiving neuraxial labor analgesia [5, 6].
An obstetric anesthesia survey approved by the New York Medical College Institutional Review Board was designed on the SurveyMonkey® website and sent to anesthesiologists practicing obstetric anesthesia in the United States of America; no patients were involved in this study, which was strictly limited to a collection of personal responses from practicing physicians. The survey was distributed through the Society of Obstetric Anesthesia and Perinatology (SOAP), all anesthesiology residency programs, and several state anesthesia societies nonselectively. Resident physicians were not included in the study since they are unlikely to be practicing independently without supervision. To avoid duplication of responses, anesthesiologists were advised to refrain from answering the survey if they had taken it once. Participation in the survey was voluntary, and responses were completely anonymous.
The distribution of the responses to the six questions related to the demographic categories of responding physicians are presented in Table 1.
Most of the anesthesiologists in our survey were agreeable to the presence of a visitor in the room while doing the neuraxial labor analgesia procedure. The preferences of patients and their expectations of physicians can change with times. The parturient may like to have a familiar person in the room to reassure her while undergoing the neuraxial labor analgesia procedure. This person can be the husband, a partner, a friend, a family member, or even a nonmedical semiprofessional person like a doula. This may reflect a changing social environment. The specialty of anesthesiology may be adapting positively to those changes.
The ASA task force on obstetric anesthesia guidelines supports a multidisciplinary approach to create favorable maternal and fetal outcomes . Our research study was done to determine attitudes and opinions of obstetric anesthesiologists towards visitor presence. The practice of visitor presence during placement of neuraxial labor analgesia appears to be gaining acceptance with anesthesiologists. Patient’s rights, visitor concerns, benefits, and risks should be weighed before a decision is made. Limited literature exists on this subject in obstetric anesthesia. Further studies need to be done to ascertain the advantages and disadvantages of this practice.