Epidural analgesia and intravenous analgesia with opioids are two techniques for providing pain relief for women in labour. Labour pain is comparable to surgical pain in its severity, and epidural analgesia provides better relief from this pain than intravenous analgesia; a meta-analysis quantified this improvement to be 40mm on a 100mm pain scale during the first stage of labour. Epidural analgesia also has fewer adverse effects. However, providing epidural analgesia for labour pain costs more. The full cost of providing epidural analgesia can be divided into two components: (i) a baseline-cost component, which captures the costs of hospital care to parturients receiving intravenous analgesia for labour pain; and (ii) an incremental-cost component, which estimates the costs arising from incremental care specific to epidural analgesia. The baseline component may be constructed using hospital cost-accounting data pertaining to actual obstetric patients. The incremental component is constructed from a set of recognised complications of epidural and intravenous analgesia, associated incidence rates and estimates of the costs involved, from society’s perspective. The incremental expected cost per patient to society of providing epidural analgesia was calculated to be approximately $US338 (1998 values). This cost difference results primarily from increased professional costs (and is particularly sensitive to the method used to estimate the cost of anaesthesia professional services) and increased complication costs associated with epidural analgesia. A rational social policy for providing labour analgesia must weigh the value of improved pain relief from epidural analgesia against the increased cost of epidural analgesia.

Economic considerations related to providing adequate pain relief for women in labour: comparison of epidural and intravenous analgesia.

Objectives: Epidural analgesia (EA) is an effective and safe method to relieve labor pain. Little is known about the factors associated with decision on EA. We applied Multiattribute Utility (MAU) theory to ascertain possible factors on which we based to predict whether parturients would receive EA or not (non-EA) during their labor. Methods: A hierarchical questionnaire on the basis of MAU theory was designed by experts to include individual attributes, knowledge and attitude toward EA and cue factors. Items in the questionnaire were compared between the EA and the non-EA groups. Receiver operating characteristics curve was used to assess predictive validity of the MAU model. Results: Of 167 parturients responding to the questionnaire, 151 participants (75 EA and 76 non-EA groups) completed all questions. Parturients in the EA group had significantly higher education level (rate of junior college or above: 88% vs. 67%, P = 0.002). There were also more primiparae in the EA group compared with non-EA group (76% vs. 46%, P<0.001). For items in MAU model, 12 out of 20 items revealed significant differences between the 2 groups. Among them, ‘‘fear of side effects,’’ ‘‘fear of severe complications,’’ and ‘‘fear of needle’’ had the most remarkable differences. The area under receiver operating characteristics equaled to 0.91 (95% confidence interval = 0.86, 0.96) for prelabor decision and 0.83 (95% confidence interval = 0.76, 0.89) for final decision.

Decision analysis for epidural labor analgesia with Multiattribute Utility (MAU) model.

A survey of regional analgesia and anaesthesia for obstetrics in selected countries in the Far East

A b s t r a c t Background There is little information on the factors that influence epidural uptake in the Middle East. Anecdotal evidence suggests that the uptake is low, overall, but rising due to socio-economic change and increased awareness of analgesia options in labour. The low prevalence of epidural in labour is influenced by many factors; however, there is a general lack of information about epidurals, both risks and benefits. Methods This study was a questionnaire -based study eliciting women’s knowledge of epidural analgesia immediately post-delivery. It was based on a survey using a questionnaire with, largely, closed questions, with one final section inviting open-ended comments. Findings Almost half of the women stated that they did not want an epidural in labour (49.2%, n=125). About a fifth of the respondents (18.1%, n=46) stated that they planned to have an epidural. However, 44 women were undecided (17.3%) and 39 women (15.4%) stated that they did not know about epidurals. The main reason given for considering an epidural was for pain relief (37.7%, n=95), although the same percentage of women (37.8%, n=96) were clear that they did not want an epidural. Other reasons attracted few responses. Discussion This study demonstrated the lack of knowledge and understanding of epidurals by women in this region. However, some of the reasons for reluctance in accepting epidural analgesia may have cultural roots and this warrants further investigation. Pain relief options available to women should be discussed early in pregnancy by doctors and midwives, who understand the cultural societal norms and who are able to give evidence-based information about the choices available.

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A Survey of Women's Views of Epidural Analgesia in the Middle East

Background: Pain relief is an important issue for women in labour. Epidural analgesia provides safe and effective pain relief. But It has not been fully accepted and is not routinely practiced in most of the centres in developing countries despite of many advantages of this technique. Therefore, this study has been conducted with an objective to assess the knowledge and attitude regarding epidural analgesia among expectant mothers. Methods: A descriptive study was conducted on 60 expectant mothers visiting antenatal OPD at DMC & Hospital, Ludhiana selected by convenience sampling technique. Knowledge assessed by using a structured questionnaire and attitude assessed by 3 point likert scale regarding epidural analgesia. Analysis was done using both descriptive and inferential statistics. Results: The findings of the study revealed that 46.7% expectant mothers had below average level of knowledge, 35% had average level of knowledge and 18.3% had good level of knowledge. 96.7 % had positive attitude and only 3.3 % had negative attitude towards epidural analgesia. Correlation between knowledge with attitude was to be significant (r=0.609; p=0.000). Conclusions: Thus, the study concluded that most of women had below average level of knowledge and but they showed positive attitude regarding epidural analgesia.

Knowledge and attitude regarding epidural analgesia among expectant mothers

Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.

Acceptability of epidural analgesia for pain relief during labour among Kelantanese women.

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Acceptability of epidural analgesia for pain relief during labour among Kelantanese women.