Postpartum patients who receive an epidural infusion during labor for pain control are at increased risk of falling when attempting to ambulate for the first time. A comprehensive literature review revealed only one obstetric fall risk screen that had not been tested in the clinical setting. No research was found that addressed the unique situation of the postepidural, postpartum patient. The objective of this study was to determine whether return of motor function in the lower extremities could be used as the marker for safe ambulation.
Descriptive, observational design.
Low/moderate risk intrapartum/postpartum patients who received an epidural for pain control during labor.
One hundred low/moderate risk obstetric patients with an epidural. Exclusion criteria included cesarean birth and Baseline Muscle Strength Scale of <4.
Obstetric registered nurses assessed study patients’ deep tendon reflexes and motor strength using the Motor Strength Scale prior to receiving epidural anesthesia and again prior to ambulating postpartum. If a subject's deep tendon reflexes and/or Motor Strength Scale scores did not return to baseline following receipt of epidural anesthesia, the subject was not ambulated and was re-assessed prior to next ambulation attempt. If a subject's scores returned to baseline, the subject was assisted with ambulation. The nurses evaluated the subject's success in ambulation using the following criteria: ambulating without lower extremity weakness or buckling of knees. Data were gathered and entered by the registered nurses onto the data sheet assigned to each subject.
Data were collected on 100 subjects. Of this number, 91 (91%) subjects successfully ambulated. Nine (9%) required assistance on ambulation. There were no falls.
Conclusion/Implications for Nursing Practice
The results supported the assessment of return to baseline levels deep tendon reflexes and Motor Strength Scale for indication of readiness to ambulate. The results of this study support the addition of these assessments into the standard of care for the postpartum patient.