Re: epidural and food
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Sep 14 20:09:53 2006
At Thu, 14 Sep 2006, GIN11153@aol.com wrote:
>
>I have not heard about the 'no food for 8 hours prior' attitude, but here in
>So. Calif., many smaller hospitals have had to stop offering epidurals for
>labor because the anesthesiologists are refusing over MediCal reimbursement
>issues (which I thought was totally illegal for them to do that). They will only
> do an epidural or spinal for a c/section!
>
>Gail Neuman RNC CPHW SNP
>student nurse practitioner and student midwife
>Perinatal education
>Perinatal Nurse Associates
>Santa Ana, CA
Committee
Opinion
ACOG
Committee on
Obstetric Practice
American Society of
Anesthesiologists
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Number 295, July 2004 (Replaces No. 231, February 2000)
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Pain Relief During Labor
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ABSTRACT: Pain management should be provided whenever medically
indicated. The American Society of Anesthesiologists (ASA) and the
American College of Obstetricians and Gynecologists (ACOG) believe that
women requesting epidural analgesia during labor should not be deprived
of this service based on their insurance or inadequate nursing
participation in the management of regional analgesic modalities.
Furthermore, in an effort to allow the maximum number of patients to
benefit from neuraxial analgesia, ASA and ACOG believe that labor nurses
should not be restricted from participating in the management of pain
relief during labor.
Labor causes severe pain for many women. There is no other circumstance
where it is considered acceptable for an individual to experience
untreated severe pain, amenable to safe intervention, while under a
physician's care. In the absence of a medical contraindication,
maternal request is a sufficient medical indication for pain relief
during labor. Pain management should be provided whenever medically
indicated.
Of the various pharmacologic methods used for pain relief during labor
and delivery, neuraxial analgesia techniques (epidural, spinal, and
combined spinal–epidural) are the most flexible, effective, and least
depressing to the central nervous system, allowing for an alert
participating woman and an alert neonate. The American Society of
Anesthesiologists (ASA) and the American College of Obstetricians and
Gynecologists (ACOG) believe that women requesting epidural analgesia
during labor should not be deprived of this service based on their
insurance or inadequate nursing participation in the management of
regional analgesic modalities. In addition, third-party payers who
provide reimbursement for obstetric services should not deny
reimbursement for labor analgesia because of an absence of "other
medical indications." Although the availability of various methods of
labor analgesia will vary from hospital to hospital, within an
institution the methods available should not be based on a patient's
ability to pay. Furthermore, in an effort to allow the maximum number
of patients to benefit from neuraxial analgesia, ASA and ACOG believe
that labor nurses should not be restricted from participating in the
management of pain relief during labor. Under appropriate physician
supervision, labor and delivery nursing personnel who have been properly
educated and have demonstrated current competence should be able to
participate in the management of epidural infusions, including adjusting
dosage and discontinuing infusions.
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“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
