Anaesthetists' experiences with the early labour epidural recommendation for obese parturients: a qualitative study.
Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015. Leximancer™ text analysis software applied a validated algorithm to the data to identify themes and concepts. The major themes were explored by the first author to answer the research question. Three major themes were identified: the demands associated with caring for obese women; concern regarding the anaesthetic technique used in obese women; and the importance of communication with obstetric staff. Disagreement regarding interpretation and application of early epidural analgesia was identified within this group of anaesthetists. These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients.
Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland.
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Eley
Obstetric Physician, School of Medicine, The University of Queensland, Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland.
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Callaway
Professor, Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland.
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van Zundert
Professor, Intensive Care Medicine, Royal Brisbane and Women's Hospital, The School of Medicine, The University of Queensland Faculty of Health, Queensland University of Technology, Brisbane, Queensland.
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Lipman
Emeritus Professor, School of Psychology, The University of Queensland, Brisbane, Queensland.
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Gallois
D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000072077:Anesthetists; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D036301:Qualitative Research
obesity, morbid, pregnant women, epidural analgesia, obstetric anaesthesia