Annotated Bibliography - Obstetric Neuraxial Analgesia (Annotated Bibliography Sample)

Annotated Bibliography Student’s Name Institutional Affiliation Fall 2023 Relevant Literature Neuraxial analgesia has gained widespread adoption in modern obstetric practices due to its positive impacts on maternal safety, making it the preferred analgesic approach during childbirth. According to Butwick et al. (2016), women who receive neuraxial analgesia have lower anesthesia-related morbidity and mortality rates than those who deliver with general anesthesia. Neuraxial analgesia can also prevent the childbirth complications typical of general anesthesia, including airway and aspiration management challenges. This anesthetic modality also affords significant maternal-fetal benefits, such as reduced postpartum hemorrhage and surgical site infections, prompt return to optimal bowel function, and enhanced ambulation and post-anesthesia outcomes (Butwick et al., 2016). Nevertheless, research suggests significant ethnic/racial disparities in the management of labor and childbirth pain. Specifically, African American and Hispanic parturients are less likely to receive neuraxial analgesia rather than general anesthesia compared to Caucasian women, potentially exposing them to a disproportionate risk of adverse peripartum outcomes (Khusid et al., 2023). However, the extant literature lacks consensus on the prevalence and characteristics of these disparities, largely due to methodological differences in research, most of which is limited to single institutions or specific regional databases. Therefore, the proposed systematic review will investigate and describe the ethnic/racial inequalities in neuraxial analgesia use among laboring women to bridge the knowledge gap. The maternal role attainment theory defines the progressive developmental and interactional process through which mothers form attachments with their infants, become competent in the inherent tasks of care-taking, and express gratification, confidence, and pleasure in the role, culminating in a distinct maternal identity (Frese & Nguyen, 2022). This midrange theory applies to all stages of motherhood, from pregnancy to postnatal care. It entails a four-stage process. In the first anticipatory phase, alternatively described as commitment, attachment, and preparation, mothers make psychological adjustments during pregnancy and prepare for the expectations of the new role. The second formal stage is characterized by acquaintance, learning, and physical restoration, whereby mothers assume and learn their roles within their social contexts after birth. The third phase is informal, and entails individuals forming mothering methods that match their lifestyles independent of their social systems. Finally, the personal or maternal identify development stage occurs when mothers internalize their new roles and experience a sense of competence, confidence, harmony, and the joy of motherhood (Rafii et al., 2020). The maternal role attainment theory elucidates how emotional, prescriptive, and normative notions related to pregnancy, the associated physical changes, and social expectations of motherhood influence the childbearing process. Therefore, this theory can be used to explain laboring women’s experiences and explore different care models and maternity interventions that can improve the mothers’ experiences during the peripartum period. Specifically, this theory underscores subjective perceptions of one’s performance during labor and birth, in addition to mothers’ mental states, sense of mastery, parity, self-esteem, previous childcare experience, age, and self-efficacy, as key predictors of maternal competence (Frese & Nguyen, 2022). The latter, in turn, influences the quality of the relationship and bond between mothers and their infants. Of note, the transition into motherhood is an important and dynamic phase of a woman’s life that involves a broad range of experiences, including pain, vulnerability, emotional distress, role changes, physical injury, and the adoption of new responsibilities (Erfina et al., 2019). Accordingly, the maternal role attainment theory is applicable to pain management studies in maternity settings, particularly the equitable administration of obstetric neuraxial analgesia during labor. The theory accentuates the significance of resilience in navigating the delicate interplay between societal demands, personal elements, and physical bodily changes during childbirth, enabling women to overcome the numerous challenges of labor and childbirth (Erfina et al., 2019). As such, from a nursing perspective, care providers should take measures to boost mothers’ resilience and provide appropriate physical and psychological support during labor. Further, the theory brings to light the inherent ethical aspects of maternity nursing that are based on the principles of justice, beneficence, autonomy, and patient-centered care. Indeed, Rafii e al. (2020) argue that nurses play a vital role of optimizing the outcomes of childbirth throughout the maternal cycle and have a duty to educate mothers and promote health and growth during, before, and after pregnancy. Thus, the maternal role attainment theory relates to the analysis of the racial and ethnic disparities in obstetric neuraxial analgesia use during labor because it highlights maternity staff’s responsibility to ensure that the childbirth process is an uneventful as possible for patients without discrimination to enhance maternal competence. Search Strategy The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to conduct a literature search of relevance and eligible literature on the racial/ethnic disparities in neuraxial analgesia use among laboring women. The databases used included Medline Complete, Cochrane, Embase, ProQuest, CINAHL, ScienceDirect, and Google Scholar. The literature was identified using various search terms, including “neuraxial analgesia”, “epidural analgesia”, “obstetric pain management”, “anesthesia”, “local anesthesia”, “spinal epidural analgesia”, “regional anesthesia”, “spinal analgesia”, “nerve block”, “peripartum period”, “first stage labor”, “second stage labor”, “labor pain” “postpartum pain management”, “parturients”, and “racial and ethnic disparities”. These search terms were combined with the Boolean operators, “AND” and “OR”, the date range limiter was used when applicable. The search was conducted by two doctoral students with the help of the university librarian. The primary search yielded 20,783 articles, with an additional 177 papers identified by searching Google Scholar. 314 duplicate records and 20,287 articles that did not directly answer the research question were removed, leaving 496 articles for screening per the inclusion and exclusion criteria. Literature Selection Two doctoral students screened the articles independently. The titles and abstracts were first reviewed, after which those that sufficiently answered the research question were subjected to thorough screening. Articles were included if they investigated obstetric neuraxial analgesia use among an ethnically or racially diverse population of human parturients in the peripartum period. The study subjects had to be women of childbearing age presenting with spontaneous first or second stage labor, and receiving labor augmentation or induction. The patients had to be capable of freely preferring or requesting neuraxial labor analgesia, either epidural or spinal-epidural analgesia, and providing informed consent. Further, studies were eligible for inclusion if they provided level I or II evidence with full-text records published in English within the past 10 years. The search focused on identifying randomized control trials (RCTs), analytical cross-sectional studies, cohort studies, and systematic reviews and meta-analyses of RCTs or cohort studies. Quasi-experimental studies, qualitative studies, case series were also considered for inclusion after rigorous evaluation of their methodologies. Studies that analyzed systemic opioid analgesia, patient-controlled analgesia pumps, non-pharmacological labor anesthesia, nerve or pudendal blocks, or neuraxial labor analgesia usage patterns in an ethnically or racially homogenous sample of patients were excluded. Studies on patients with comorbid medical or mental conditions, severe labor pains, those under midwife services, those who gave birth shortly after hospital admission, or with significant missing data regarding neuraxial labor analgesia use were also excluded. Studies involving patients in third-stage labor or those experiencing non-spontaneous labor were not included. Of the 496 articles screened, 486 were excluded after applying the inclusion and exclusion criteria. 10 articles were retrieval, one of was excluded because the full-text article could not be found. The remaining nine articles were screened further by two independent doctoral students, after which three were deemed not eligible because they did not fit the inclusion and exclusion criteria fully. Moreover, of the 177 articles identified from Google Scholar, only five were sought for retrieval, two of which were excluded after screening for eligibility. The final search yielded nine articles that will be included on the proposed research (Appendix). Annotated Bibliography Racial and Ethnic Disparities in the Use and Timing of Obstetric Neuraxial Analgesia Brebion, M., Bonnet, M. P., Sauvegrain, P., Saurel-Cubizolles, M. J., Blondel, B., Deneux-Tharaux, C., & Azria, E. (2021). Use of labor neuraxial analgesia according to maternal immigration status: A national cross-sectional retrospective population-based study in France. British Journal of Anesthesia, 127(6), 942-952. https://doi.org/10.1016/j.bja.2021.08.011 Brebion et al. (2021) conducted a retrospective, cross-sectional, population-based study to evaluate the ...