Posted: January 3rd, 2024

Response Paper

Ethical Dilemma
An issue that I have faced on the unit I work on, has been a patient receiving their epidural before morning. I work night shift and in Labor and Delivery. Whether or not a patient wants to use an epidural as a way of pain management during vaginal birth is their choice. A practice that doctors do in the morning is they make rounds and break the patients’ amniotic sac, if it has not already broken on its own. This is an attempt at decreasing the amount of time the patient is in labor. There are times where this is not possible. I have not experienced childbirth myself, but from what I have learned from patients, is that this process may not be comfortable. I have heard and come to see that some of the doctors prefer for their patients to have epidurals (if that is something that the patient wants) before they come to break water in the mornings. I have had a doctor get slightly upset with me because the patient did not have their epidural yet. I had to state to the doctor several times that an epidural had been discussed with the patient, as well as what would be next that could potentially cause them pain, aside from labor itself, and the patient was not ready for their epidural just yet. It is not a requirement for a patient to have an epidural before their labor process progresses. I believe that this is the patient’s decision. I can understand wanting to further prevent the patient’s pain, but I can also see it as a way of trying to make other aspects of the job easier. For example, many times doctors will perform a cervical exam when breaking water. Cervical exams may not be a comfortable experience. If the patient has an epidural to where they are numb half way down their body, the patient will not become as tense during these processes. All in all, it is the patient’s decision. Throwing around the option of an epidural to make one person’s job easier, goes against that patient’s autonomy, which is the freedom for them to choose, be involved in the decision making in their care, and makes them not fully informed (Rector & Stanley, 2022).
References
Rector, C., & Stanley, M. J. (2022). Evidence-based practice and ethics. Community and public health nursing. (10th ed., pp. 37). Wolters Kluwer Medical.

Ethical Dilemma Response Paper

Ethical Dilemma Response Paper
I agree with you that the use of epidural as a way of managing pain during vaginal childbirth should always be the patient’s choice. I do not see the reason why there should be a bone of contestation between doctors and nurses over why an epidural has not been administered yet if the patient is not willing to undergo the process. If healthcare providers use the intervention process just for the sake of making their work easier, it could result in unethical practice.
The duty of care, as stipulated by the code of ethics governing patient care operations, requires clinicians to act responsibly to protect the safety and well-being of the patients. The latter includes taking every reasonable precaution to avoid any foreseeable harm and alleviate suffering. Many healthcare providers recommend an epidural for their patients during the time of giving birth because of its effectiveness in numbing the nerves and muscles in the lower body, thus effectively managing pain. However, the procedure is associated with several detriments, such as prolonged labor and delivery process (Abu Hammad & Alholi, 2021). It can also cause a dysfunction in a mother’s muscles, incapacitating their normal function of pushing the baby out.
Our duty as nurses should always be to ensure ultimate care for the patients put under our care. Patients’ safety and well-being should always come before any other call of duty. The law requires a patient’s consent before certain care intervention procedures are administered. I support your argument that an epidural is the patient’s decision because it is in agreement with the law. I believe the reason why patients avoid epidurals may be due to a lack of proper knowledge, misconceptions, or the patient’s preference to experience childbirth naturally. The healthcare standards for care promotion would require us to openly discuss pain management measures such as epidurals with expectant mothers and allow them to make decisions instead of advising them to undertake the procedure mindlessly.

Reference
Abuhammad, S., & Alholi, E. (2021). Epidural analgesia and related ethical issues among pregnant women: Literature review. Annals of Medicine and Surgery, 65, 102305.

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