Women's attitude toward analgesia during labor--a comparison between 1995 and 2001.

Analgesia and satisfaction in childbirth

Women frequently request regional analgesia during labour, yet little is known about how long it takes before they become comfortable. This prospective observational study aimed to determine various time-points following maternal request for regional analgesia in labour until comfort was achieved. It was conducted in two tertiary referral centres for maternity care in Australia between December 2009 and May 2010.Midwives and anaesthetists recorded times of maternal request for regional analgesia, anaesthetist contact,anaesthetist's arrival in the labour room, local anaesthetic infiltration on starting the procedure, injection of neuraxial local anaesthetic and first report of maternal comfort. Composite median times and interquartile range were recorded for maternal request to anaesthetist arrival, anaesthetist arrival to maternal comfort and total time from request to comfort. Statistical modelling and regression analyses assessed possible factors associated with these time intervals. A P value <0.05 was considered significant. Of the 324 maternal requests, 244 out of 324 (75.3%, 95% confidence interval 70.2% to 79.9%) were recorded as having achieved satisfactory labour analgesia. Median interquartile range times observed were: maternal request to anaesthetist arrival: 20 (10 to 35) minutes; anaesthetist arrival to maternal comfort: 40 (30 to 50) minutes; and total time from request to comfort: 65 (50 to 85) minutes. We have shown that approximately one hour is required for a mother to achieve comfort following her request for epidural analgesia during labour. Our findings are likely to provide useful information for antenatal education, enhance informed consent and improve the provision of anaesthetic services for labour analgesia.

Time to get comfortable with a labour epidural.

: Background: Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women’s characteristics, prenatal care, and type of maternity unit. Methods: The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women’s choice to deliver without epidural analgesia were studied with multivariable analyses. Results: Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in nonuniversity public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site. Conclusions: Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor. (BIRTH 35:3 September 2008)

Factors associated with the choice of delivery without epidural analgesia in women at low risk in France.

To study women's views on epidural analgesia, three groups of primiparous women were compared. In the first group (41 women), they were given epidural analgesia, after having asked for it during pregnancy. In the second group (79 women), epidural analgesia was given during labour although it had not been planned during pregnancy. The third group included 60 women who underwent labour and delivery using the preparation for childbirth technique alone. The data showed differences between the three groups from medical and social points of views. Women in the first group were of a higher social status than the others; they had been more often admitted to hospital during their pregnancy. Women of the second group more frequently explained that they had psychosocial problems during pregnancy. Furthermore, women who had planned an epidural explained that their choice was mainly due to anxiety. On the other hand the majority of women were rather hostile to this technique. Even though women pointed out the physical and psychological relief due to epidural analgesia, there was no obvious difference in maternal satisfaction between the three groups. Maternal satisfaction with the birth experience was related rather to the moment when the epidural analgesia had been decided on, before or during labour, to the attitude of the medical staff and to the hospital standards for labour and delivery. Advance planning of an epidural analgesia also appeared to be insufficient to keep control of the whole process of childbirth and particularly of its psychological meanings. The study showed that even with a perfect technique, epidural analgesia is not the only possible answer to women's anxiety.

[Epidural analgesia. Women's viewpoint].

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[Epidural analgesia. Women's viewpoint].