Anesthesia — Foundation of Discipline

F12a Assessing and providing labour analgesia for healthy parturients with an uncomplicated pregnancy, including the management of common complications of labour analgesia

Key Features:
- This EPA may include any of the following complications: inadequate control of pain,
hypotension, bradycardia, fetal bradycardia and decelerations, respiratory
depression, unilateral block, high block and/or inadvertent subarachnoid block.
- The observation of this EPA is divided in 2 parts; assessment, provision and
management of labour analgesia; management of common complications.
- This EPA includes direct observation of procedural skills (e.g. epidurals).
- Observations of both parts may be done on the same occasion.

Form

F1: Observation

Milestones

• ME 1.3. Apply clinical and biomedical sciences to manage presentations in pregnant patients

• ME 1.4. Perform focused clinical assessments of a parturient during labor, acknowledge limitations of the assessment in this specific context and demonstrate strategies to overcome those limitations

• ME 3.1. Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy to provide optimal labour analgesia

• ME 2.4. Integrate all sources of information to develop and initiate a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches

• ME 2.2. Analyze fetal heart rate monitoring before and after provision of labour analgesia

• ME 3.2. Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies

• ME 3.4. Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning

• ME 3.4. Perform labour epidural analgesia or other common procedures to provide labour analgesia in a skillful, fluid, and safe manner, including appropriate sterile technique

• ME 4.1. Ensure adequate follow up of the parturient receiving labour analgesia

• ME 3.4. Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered

• COM 1.2. Optimize the physical environment for patient comfort, privacy, engagement, and safety

• COM 4.1. Communicate with cultural awareness and sensitivity

• COM 5.1. Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

• COL 1.1. Receive and appropriately respond to input from other health care professionals

• COL 1.3. Integrate the patient’s perspective and context into the collaborative care plan

• L 4.1. Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

• HA 1.2. Select patient education resources related to obstetrical analgesia and anesthesia

• S 3.3. Interpret study findings, including a critique of their relevance to their practice

Context Variables

• Patient BMI (free-text)
• Patient's weight (free-text)
• Type of observation (single-choice)
  • direct
  • case review
• Type of analgesia provided (single-choice)
  • epidural
  • other analgesia

Requirements

• Collect a minimum of 10 observations (minimum 10)
• At least 6 direct observations