Neuraxial Anesthesia and the Supine Position Cause Non-reassuring Fetal Status

Abstract

An 18-year-old woman, G1P0, presents to Labor & Delivery at 40 weeks estimated gestational age with severe labor pain. Her cervix is 2–3 cm dilated and she urgently requests an epidural (L-1). The anesthesia resident places the epidural uneventfully and doses it liberally since the patient complains of severe pain (L-2). Soon the patient feels much better as the epidural starts to work (L-3). The anesthesia resident has already given a 500 mL “co-load” of lactated Ringer’s solution (LR) and now gives the patient 50 mcgm of phenylephrine IV. He explains to her why it is important for her and her fetus that she labor lying on one side or the other—but not to lie flat on her back—and he stays in the patient’s room doing his documentation long enough to make sure that the neuraxial block is not going too high (L-4).