- Email: [email protected]
Ethnicity, trans-cultural differences in childbirth experience and use of labor analgesia: a “real life experience”
662
Lettres à la rédaction / Annales Françaises d’Anesthésie et de Réanimation 23 (2004) 658–663
Références [1]
[2]
Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and vascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78: 507–14. Haberer JP. Accidents de surdosage de la ropivacaïne et de la lévobupivacaïne. Cah Anesthésiol 2003;51:383–7.
C. Leclerc * J. Rouaud P. Haond P. Bottet C. Bonnamy Unité de chirurgie ambulatoire, fondation de la Miséricorde (PSPH), CHU, 14000 Caen, France Adresse e-mail : [email protected] (C. Leclerc). * Auteur correspondant. Service de chirurgie ambulatoire, fondation de la Miséricorde, 15, Fosses-Saint-Julien, 14000 Caen, France.
Subtle trans-cultural differences in the childbirth experience can sometimes cause peripartum care-related conflicts and effect/impact the use (both over-use or under-use) of peripartum labor analgesia [2]. Childbirth outcomes including the usage of labor analgesia may vary depending on whether laboring women’s husbands (partners) are present during labor or not [3]. Epidural analgesia is recommended more often to low parity, younger women exhibiting more pain. Parturient who perceive greater pain are more secular, have low parity, and have a higher level of education are more likely to accept it [4]. Women who refuse labor analgesia experience (and apparently express) lower degrees of labor pain. Parturients refusing analgesia are usually older than women using labor analgesia [5]. Ethnicity of the laboring parturient may impact both the quality and quantity of obstetrical analgesia [6].
Ethnicity, trans-cultural differences in childbirth experience and use of labor analgesia: a “real life experience”
Every aspect of our lives (as human beings) is affected by our culture, and it is much easier to observe cultural differences in others than it is to identify our own cultural expectations and norms [7]. We (as health care providers) believe that our own culture is normal and natural, when indeed very few human activities are purely instinctual and/or natural. In our roles as peripartum health care providers we must therefore respect the choices laboring women make even when we may not personally agree with those choices (e.g. acceptance versus rejection of labor analgesia).
Influence de l’origine ethnique et des différences culturelles sur l’expérience de l’accouchement et de l’analgésie au cours du travail
While many parturients present with a significant amount of prior knowledge regarding pain control in labor, others may have little or no understanding of the labor and delivery and labor analgesia [8].
Disponible sur internet le 14 mai 2004 © 2004 Elsevier SAS. Tous droits réservés. doi:10.1016/j.annfar.2004.03.012
Keywords: Labor analgesia; Epidural; Quality; Availability; Maternal satisfaction; Obstetric anesthesia; Culture; Ethnicity Mots clés : Analgésie obstétricale ; Qualité ; Indice de satisfaction ; Culture ; Ethnie
I read with interest the recent article by Sandefo et al. [1], which evaluates the “real-life experience” (as the authors phrased it), quality (degree of patient’s satisfaction), and availability (quantity), and equality (for that matter) of labor analgesia in Martinique versus mainland France. The authors are to be congratulated for conducting such a comprehensive, thought-provoking and well-referenced study discussing the polarized and controversial issue of an impact of ethnicity and trans-cultural differences in childhood experience on use of labor analgesia (if any?) [1]. The author of this letter would like to add the following comments (supported by other important studies) to this comprehensive and timely study.
It is important to point out that the stress and discomfort experienced by the parturient in labor do not interfere with their ability to hear and comprehend the information associated with the consent process prior to administration of labor analgesia [9]. Epidural analgesia is widely considered as the most effective method of providing pain relief during labor. However, epidural labor analgesia is not a generic procedure and many technical modifications (e.g. combined spinal epidural versus conventional epidural labor analgesia) have been introduced over time [10]. Nevertheless, (and in conclusion) one issue, which has remained unchanged no matter what technical modifications apply to a particular neuraxial block, is the degree of patient’s satisfaction with the peripartum care, which has often been assessed by a simple statement that describes the degree of the patient’s satisfaction with the pain relief from her labor epidural analgesia [11].
Lettres à la rédaction / Annales Françaises d’Anesthésie et de Réanimation 23 (2004) 658–663
663
Mots clés : Analgésie péridurale ; Anesthésie obstétricale ; Cathéter péridural ; Déconnexion
References [1]
Sandefo I, Lebrun T, Polin B, Van Elstraete A, Alla F. Analgésie péridurale de travail en Martinique: évaluation de la qualité et de l’accessibilité à l’analgésie péridurale par les parturientes dans une clinique obstétricale de niveau 1. Ann Fr Anesth Réanim 2004;23:26– 30. [2] Yeo S, Fetters M, Maeda Y. Japanese couples’ childbirth experiences in Michigan: implications for care. Birth 2000;27:191–8. [3] Ip WY. Chinese husbands’ presence during labour: a preliminary study in Hong Kong. Int J Nurs Pract 2000;6:89–96. [4] Sheiner E, Sheiner EK, Shoham-Vardi I, Gurman GM, Press F, Mazor M, et al. Predictors of recommendation and acceptance of intrapartum epidural analgesia. Anesth Analg 2000;90:109–13. [5] Sheiner E, Shoham-Vardi I, Ohana E, Segal D, Mazor M, Katz M. Characteristics of parturients who choose to deliver without analgesia. J Psychosom Obstet Gynaecol 1999;20:165–9. [6] Vangen S, Stoltenberg C, Schei B. Ethnicity and use of obstetrical analgesia: do Pakistani women receive inadequate pain relief in labour? Ethn Health 1996;1:161–7. [7] Van Hoover C. Pain and suffering in childbirth. A look at attitudes, research and history. Midwifery Today Int Midwife 2000;55:39–42. [8] Kuczkowski KM. Childbirth with labor analgesia: what is important to our patients? Anaesthesist 2004;53:90. [9] Kuczkowski KM. Informed consent, the parturient, and obstetric anesthesia. J Clin Anesth 2003;15:573–4. [10] Crass D, Friedrich J. Epidural analgesia during childbirth. Anaesthesist 2003;52:727–44. [11] Morgan BM, Kadim MY. Mobile regional anesthesia in labour. Br J Obstet Gynecol 1994;101:839–41.
Krzysztof M. Kuczkowski Departments of Anesthesiology and Reproductive Medicine, University of California at San Diego, UCSD Medical Center, 200 W Arbor Drive, San Diego, CA 92103-8770, USA E-mail address: [email protected] (K.M. Kuczkowski). Available online 14 May 2004 © 2004 Elsevier SAS. All rights reserved. doi:10.1016/j.annfar.2004.04.003
Epidural catheter disconnection: an equipment failure or an operator error?
Déconnexion du cathéter péridural: problème de matériovigilance ou erreur humaine? Keywords: Labor analgesia; Epidural analgesia; Complications; Epidural catheter; Disconnection; Management; Obstetric anesthesia
Two reports [1,2] have recently focused on management of accidental disconnection between epidural catheter and its luer-lock connector in obstetric anesthesia listing the most common recommendations, which include simple reconnection of the catheter (2%), cleaning of the outside of the catheter and reconnecting it (15%), cutting a portion of the catheter and reconnecting it (4%), cleaning the outside of the catheter, cutting a portion and reconnecting it (44%), and finally removing the epidural catheter (35%) [2]. Cohen et al. [1] speculated that some catheter/luer-lock connector designs (e.g. a screw cap catheter/connector design) may be more prone to accidental disconnection than others (e.g. single snap catheter/connector design). In his practice of obstetric anesthesia at the University of California, San Diego the author of this letter uses B. Braun 20 GA closed tip radiopaque polyamide epidural catheter (B. Braun Medical Inc., Bethlehem, PA 18018, USA) with screw cap catheter connector and the incidence of accidental catheter disconnection (even in parturients who receive ambulatory labor analgesia) is nearly zero (unpublished data). In conclusion, this author believes that more emphasis (attention) should be placed on prevention of accidental disconnection between epidural catheter and its connector, which is a function of an operator error (simply the screw cap is not tightened enough or the single snap cap is not connected properly by the anesthesia provider) rather than a function of an equipment malfunction/failure.
References [1] [2]
Cohen S, Sakr A, Sakr E. What do we do with a disconnected epidural catheter?—a response. Can J Anaesth 2004;51:192. Parry G. What do we do with a disconnected epidural catheter? Can J Anaesth 2003;50:523.
Krzysztof M. Kuczkowski Departments of Anesthesiology and Reproductive Medicine, University of California at San Diego, UCSD Medical Center, 200 W Arbor Drive, San Diego, CA 92103-8770, USA E-mail address: [email protected] (K.M. Kuczkowski). Available online 18 May 2004 © 2004 Elsevier SAS. All rights reserved. doi:10.1016/j.annfar.2004.04.004
Lettres à la rédaction / Annales Françaises d’Anesthésie et de Réanimation 23 (2004) 658–663
Références [1]
[2]
Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and vascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78: 507–14. Haberer JP. Accidents de surdosage de la ropivacaïne et de la lévobupivacaïne. Cah Anesthésiol 2003;51:383–7.
C. Leclerc * J. Rouaud P. Haond P. Bottet C. Bonnamy Unité de chirurgie ambulatoire, fondation de la Miséricorde (PSPH), CHU, 14000 Caen, France Adresse e-mail : [email protected] (C. Leclerc). * Auteur correspondant. Service de chirurgie ambulatoire, fondation de la Miséricorde, 15, Fosses-Saint-Julien, 14000 Caen, France.
Subtle trans-cultural differences in the childbirth experience can sometimes cause peripartum care-related conflicts and effect/impact the use (both over-use or under-use) of peripartum labor analgesia [2]. Childbirth outcomes including the usage of labor analgesia may vary depending on whether laboring women’s husbands (partners) are present during labor or not [3]. Epidural analgesia is recommended more often to low parity, younger women exhibiting more pain. Parturient who perceive greater pain are more secular, have low parity, and have a higher level of education are more likely to accept it [4]. Women who refuse labor analgesia experience (and apparently express) lower degrees of labor pain. Parturients refusing analgesia are usually older than women using labor analgesia [5]. Ethnicity of the laboring parturient may impact both the quality and quantity of obstetrical analgesia [6].
Ethnicity, trans-cultural differences in childbirth experience and use of labor analgesia: a “real life experience”
Every aspect of our lives (as human beings) is affected by our culture, and it is much easier to observe cultural differences in others than it is to identify our own cultural expectations and norms [7]. We (as health care providers) believe that our own culture is normal and natural, when indeed very few human activities are purely instinctual and/or natural. In our roles as peripartum health care providers we must therefore respect the choices laboring women make even when we may not personally agree with those choices (e.g. acceptance versus rejection of labor analgesia).
Influence de l’origine ethnique et des différences culturelles sur l’expérience de l’accouchement et de l’analgésie au cours du travail
While many parturients present with a significant amount of prior knowledge regarding pain control in labor, others may have little or no understanding of the labor and delivery and labor analgesia [8].
Disponible sur internet le 14 mai 2004 © 2004 Elsevier SAS. Tous droits réservés. doi:10.1016/j.annfar.2004.03.012
Keywords: Labor analgesia; Epidural; Quality; Availability; Maternal satisfaction; Obstetric anesthesia; Culture; Ethnicity Mots clés : Analgésie obstétricale ; Qualité ; Indice de satisfaction ; Culture ; Ethnie
I read with interest the recent article by Sandefo et al. [1], which evaluates the “real-life experience” (as the authors phrased it), quality (degree of patient’s satisfaction), and availability (quantity), and equality (for that matter) of labor analgesia in Martinique versus mainland France. The authors are to be congratulated for conducting such a comprehensive, thought-provoking and well-referenced study discussing the polarized and controversial issue of an impact of ethnicity and trans-cultural differences in childhood experience on use of labor analgesia (if any?) [1]. The author of this letter would like to add the following comments (supported by other important studies) to this comprehensive and timely study.
It is important to point out that the stress and discomfort experienced by the parturient in labor do not interfere with their ability to hear and comprehend the information associated with the consent process prior to administration of labor analgesia [9]. Epidural analgesia is widely considered as the most effective method of providing pain relief during labor. However, epidural labor analgesia is not a generic procedure and many technical modifications (e.g. combined spinal epidural versus conventional epidural labor analgesia) have been introduced over time [10]. Nevertheless, (and in conclusion) one issue, which has remained unchanged no matter what technical modifications apply to a particular neuraxial block, is the degree of patient’s satisfaction with the peripartum care, which has often been assessed by a simple statement that describes the degree of the patient’s satisfaction with the pain relief from her labor epidural analgesia [11].
Lettres à la rédaction / Annales Françaises d’Anesthésie et de Réanimation 23 (2004) 658–663
663
Mots clés : Analgésie péridurale ; Anesthésie obstétricale ; Cathéter péridural ; Déconnexion
References [1]
Sandefo I, Lebrun T, Polin B, Van Elstraete A, Alla F. Analgésie péridurale de travail en Martinique: évaluation de la qualité et de l’accessibilité à l’analgésie péridurale par les parturientes dans une clinique obstétricale de niveau 1. Ann Fr Anesth Réanim 2004;23:26– 30. [2] Yeo S, Fetters M, Maeda Y. Japanese couples’ childbirth experiences in Michigan: implications for care. Birth 2000;27:191–8. [3] Ip WY. Chinese husbands’ presence during labour: a preliminary study in Hong Kong. Int J Nurs Pract 2000;6:89–96. [4] Sheiner E, Sheiner EK, Shoham-Vardi I, Gurman GM, Press F, Mazor M, et al. Predictors of recommendation and acceptance of intrapartum epidural analgesia. Anesth Analg 2000;90:109–13. [5] Sheiner E, Shoham-Vardi I, Ohana E, Segal D, Mazor M, Katz M. Characteristics of parturients who choose to deliver without analgesia. J Psychosom Obstet Gynaecol 1999;20:165–9. [6] Vangen S, Stoltenberg C, Schei B. Ethnicity and use of obstetrical analgesia: do Pakistani women receive inadequate pain relief in labour? Ethn Health 1996;1:161–7. [7] Van Hoover C. Pain and suffering in childbirth. A look at attitudes, research and history. Midwifery Today Int Midwife 2000;55:39–42. [8] Kuczkowski KM. Childbirth with labor analgesia: what is important to our patients? Anaesthesist 2004;53:90. [9] Kuczkowski KM. Informed consent, the parturient, and obstetric anesthesia. J Clin Anesth 2003;15:573–4. [10] Crass D, Friedrich J. Epidural analgesia during childbirth. Anaesthesist 2003;52:727–44. [11] Morgan BM, Kadim MY. Mobile regional anesthesia in labour. Br J Obstet Gynecol 1994;101:839–41.
Krzysztof M. Kuczkowski Departments of Anesthesiology and Reproductive Medicine, University of California at San Diego, UCSD Medical Center, 200 W Arbor Drive, San Diego, CA 92103-8770, USA E-mail address: [email protected] (K.M. Kuczkowski). Available online 14 May 2004 © 2004 Elsevier SAS. All rights reserved. doi:10.1016/j.annfar.2004.04.003
Epidural catheter disconnection: an equipment failure or an operator error?
Déconnexion du cathéter péridural: problème de matériovigilance ou erreur humaine? Keywords: Labor analgesia; Epidural analgesia; Complications; Epidural catheter; Disconnection; Management; Obstetric anesthesia
Two reports [1,2] have recently focused on management of accidental disconnection between epidural catheter and its luer-lock connector in obstetric anesthesia listing the most common recommendations, which include simple reconnection of the catheter (2%), cleaning of the outside of the catheter and reconnecting it (15%), cutting a portion of the catheter and reconnecting it (4%), cleaning the outside of the catheter, cutting a portion and reconnecting it (44%), and finally removing the epidural catheter (35%) [2]. Cohen et al. [1] speculated that some catheter/luer-lock connector designs (e.g. a screw cap catheter/connector design) may be more prone to accidental disconnection than others (e.g. single snap catheter/connector design). In his practice of obstetric anesthesia at the University of California, San Diego the author of this letter uses B. Braun 20 GA closed tip radiopaque polyamide epidural catheter (B. Braun Medical Inc., Bethlehem, PA 18018, USA) with screw cap catheter connector and the incidence of accidental catheter disconnection (even in parturients who receive ambulatory labor analgesia) is nearly zero (unpublished data). In conclusion, this author believes that more emphasis (attention) should be placed on prevention of accidental disconnection between epidural catheter and its connector, which is a function of an operator error (simply the screw cap is not tightened enough or the single snap cap is not connected properly by the anesthesia provider) rather than a function of an equipment malfunction/failure.
References [1] [2]
Cohen S, Sakr A, Sakr E. What do we do with a disconnected epidural catheter?—a response. Can J Anaesth 2004;51:192. Parry G. What do we do with a disconnected epidural catheter? Can J Anaesth 2003;50:523.
Krzysztof M. Kuczkowski Departments of Anesthesiology and Reproductive Medicine, University of California at San Diego, UCSD Medical Center, 200 W Arbor Drive, San Diego, CA 92103-8770, USA E-mail address: [email protected] (K.M. Kuczkowski). Available online 18 May 2004 © 2004 Elsevier SAS. All rights reserved. doi:10.1016/j.annfar.2004.04.004