Reducing the risk of preventable postpartum lower extremity nerve injuries

Postpartum lower extremity nerve injuries can have a significant negative impact on mothers’ lives, as some women may not be able to walk or care for their newborn without assistance. Neuraxial analgesia may be contributing to nerve injuries by altering pain perception during the second stage of labor (pushing), resulting in the development of lower extremity nerve injury. Given the increase in the use of neuraxial (spinal, epidural, or combined spinal-epidural) labor analgesia in the United States, understanding whether this type of anesthesia is a contributing factor to nerve injury is an important goal. To date, however, studies have not had sufficient power to identify the key contributing factors. This study, therefore, will fill an important gap in the knowledge and understanding of postpartum lower extremity nerve injuries. The objective of this project is to improve identification of laboring women at risk for lower extremity nerve injury and to deconstruct the contributing factors, in order to develop targeted interventions to reduce these preventable injuries. The study has three aims, as follows: (1) To identify the maternal, fetal, anesthetic, and obstetric factors related to new onset lower extremity nerve injury, using individual-level, EHR data for a cohort of women who delivered between 2007 and 2016; (2) Identify the specific contributing factors associated with new-onset lower extremity nerve injuries, among women who use neuraxial labor analgesia; and (3) Develop and design a potential prophylactic intervention, through the use of a user-centered development and design approach with patients who experienced a postpartum lower extremity nerve injury and providers (nurses, obstetricians, anesthesiologists). This project is highly relevant to public health as childbirth is the most common reason for hospital admission in the United States and these injuries significantly impact women’s ability to care and bond with their newborns. This study will help inform an intervention that will be applicable to all women and will thus improve the quality of care for the four million women who deliver infants each year in the United States.