Presence of a Companion During Performance of Neuraxial Labor Analgesia
Presence of a Companion During Performance of Neuraxial Labor Analgesia
The purpose of the study is to evaluate if maternal anxiety is improved when a parturient
 gets her choice with regard to the presence of a companion during epidural catheter placement
 for labor analgesia. It will be focused on parturients having their first child with the
 current partner. Additionally, it will investigate the effect of ethnicity, health literacy
 (as evaluated by the Newest Vital Sign questionnaire), catastrophizing (as evaluated by the
 Pain Catastrophizing Scale), and the relationship of the support person to the parturient.
 The investigators hypothesize that there may be specific subgroups in which maternal anxiety
 is improved when a parturient gets her choice regarding the presence of a companion during
 labor epidural catheter placement; however, a significant improvement in maternal anxiety,
 when including all participants, will not be appreciated.
Parturients who have been admitted to the Labor and Delivery ward at Prentice Women's
 Hospital will be approached by a member of the anesthesia team prior to the placement of a
 labor epidural catheter. They will be asked if they are considering neuraxial labor
 analgesia, and if they are they will be screened using the inclusion and exclusion criteria
 to determine study eligibility. Once they have been evaluated and found to be appropriate for
 the study, they will be invited to participate.

 Participants will be asked to fill out the STAI questionnaire to assess the level of anxiety
 prior to placement of the labor epidural catheter, and before knowing their group assignment.
 They will then complete the pre procedure questionnaire. This questionnaire asks about
 expectations she has for the labor epidural procedure. They will then be given the page of
 the Newest Vital Signs questionnaire with the Nutrition Facts, and be asked the 6 questions
 by the recruiter. Then they will be handed the Pain Catastrophizing Scale form with 13
 statements, and asked to fill it out as directed in the instructions at the top. They will
 then be asked who their primary support person is. A form will be handed to that person to
 confidentially record if he/she would prefer to be present for the procedure. This form will
 be collected from the companion, and without the parturient aware of the support person's
 response, she will be asked for her preference with regard to the presence of a companion in
 the room, which will be recorded on this form as well. Finally, she will be asked which
 ethnicity she most relates to, also to be recorded on this form.

 After all these data have been collected, the parturient will be randomized as to whether her
 companion will be allowed in the room or will be asked to leave. This will not be
 communicated to the parturient until the time of the labor epidural catheter placement. When
 she requests the neuraxial labor analgesia, the provider placing the labor epidural catheter
 will be made aware of which group she has been randomized to, and will either ask the
 companion to leave for placement, or provide the support person a non-mobile chair to sit on
 in front of the parturient for placement of the labor epidural. The companion will be asked
 to remain in the chair. He/she will be asked to focus on the parturient. It will be
 emphasized that he/she must remain seated and will not be allowed to observe the procedure
 being performed. This is to prevent loss of consciousness in the support person, which has
 been documented in the literature (Devore and Asrani, 1978; Crosby and Halpern, 1989). One
 violation will result in a warning, and after a second the companion will be escorted out of
 the room and the participant will be removed from the study.

 The provider will place the labor epidural catheter in the regular fashion, as is common
 practice at Prentice Women's Hospital. After preparation and draping of the skin in the
 sitting position, infiltration with Lidocaine 1% will be conducted at L3-L4 or L4-L5. A 17g
 Tuohy needle will be advanced into the epidural space, using a loss of resistance with either
 saline or air, depending on the provider's preference. After the epidural space has been
 located, a 27g pencil-tip spinal needle will be placed through the Tuohy, into the
 intrathecal space, and an intrathecal dose of medication will be administered. The exact dose
 to be injected will be left up to the discretion of the provider, who will determine the
 appropriate dose based on the patient's situation at that time. After the intrathecal dose is
 administered, the spinal needle will be removed and a 19g epidural catheter will be placed
 through the Tuohy into the epidural space. It will be secured at the skin with a sterile
 dressing and tape, leaving 5cm of the catheter in the epidural space. The patient will then
 be placed in a lateral position.

 After the completion of the neuraxial procedure, the study participant will then be asked to
 fill out the STAI questionnaire again. Additionally, she will be asked to record her
 perception of pain during the placement of the labor epidural catheter, using a VAS (Visual
 Analogue Scale) from 0-100mm. At that point the parturient's participation in the study will
 be complete.

 The provider placing the labor epidural catheter will be asked to evaluate his/her ability to
 palpate landmarks for placement, the positioning of the patient, and overall perceived
 difficulty with the epidural placement, using a VAS from 0-100mm for each, which will be kept
 confidential.
Inclusion Criteria:

 -  Delivering the first child

 -  Planning to labor with neuraxial analgesia.

 -  Additionally, there will need to be sufficient time before delivery to allow the
 completion of the Pre procedure questionnaire, State-Trait Anxiety Inventory (STAI)
 questionnaire both before and after the procedure, as well as the Newest Vital Sign
 questionnaire and the Pain Catastrophizing Scale questionnaire before the procedure.

 -  They will be included if they are ASA (American Society of Anesthesiologists) 2.

 -  Able to read and comprehend the English language, as the Newest Vital Sign
 questionnaire requires them to read and interpret a nutrition label.

 Physician Inclusion:

 -  Anesthesiology Attending Physician, fellow or resident who participants in the
 placement of the epidural catheter placement

 Companion Inclusion:

 -  Primary companion identified by parturient over the age of 18

 Exclusion Criteria:

 -  Parturients will be excluded if they are receiving neuraxial anesthesia for a cesarean
 delivery,

 -  External cephalic version

 -  Non-labor procedure.

 -  Subjects will be excluded if they begin to push for delivery before completion of the
 STAI questionnaire following labor epidural catheter placement.

 -  They will be excluded if there is no support person present at the time of the
 neuraxial procedure.

 -  They will be excluded if they are ASA 3 or greater, or if they have a contraindication
 to receiving any of the medications routinely used in the placement of a labor
 epidural catheter (lidocaine, bupivacaine, epinephrine, fentanyl).

 -  Adults who are unable to consent and minors will be excluded.