Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health

Abstract

Objective To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. Methods A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross‐sectional, facility‐based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design‐based χ2 test. Results Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. Conclusion Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low‐HDI countries. Whether low use of analgesia reflects women’s desire or an unmet need for pain relief requires further studies.

Intrapartum Analgesia—Have Women’s Preferences Changed over the Last Decade?

“…There is contradictory information about the influence of parity on the primary choice of EDA, with some stating that primiparas less often than multiparas include EDA in their labor plans [9,17], with others on the contrary indicating that primiparas choose to have EDA more often than multiparas [18]. An Australian study on a group of 2445 women indicated that women who used EDA in previous labors were more likely to have EDA, as well as those with higher education or of higher income.…”

Update on Non-neuraxial Labor Analgesia

“…While neuraxial analgesia provides the most effective labor pain relief, availability, contraindications, and preferences may impact its use in labor [ 7 ]. Souza et al evaluated use of labor analgesia for vaginal delivery in Africa, Asia, Middle East, and Latin America, in a cross-sectional, facility-based survey of 359 healthcare facilities in 29 countries [ 8 ]. Sociodemographic and obstetric characteristics of laboring women who did and did not receive labor analgesia were presented.…”

“…The ability to choose efficacious analgesia options is an essential contribution to the labor experience. Prior to labor, women may seek information regarding labor analgesia options and may not necessarily have a fixed decision regarding the analgesia they prefer [1][2][3]. Many factors may impact the decision regarding labor analgesia, including concurrent comorbidities such as high body mass index, cardiac disease, obstetric history such as prior cesarean delivery, preeclampsia, and available monitoring options.…”

Labor epidural analgesia versus without labor epidural analgesia for multiparous women: a retrospective case control study

“…Epidural analgesia effectively relieves the pain during the progress of labor, but it is still not available consistently in many institutions. Though the rate of epidural analgesia using has been increased in China, nearly 57 % in some institutions recently [1], only 4 % of total women and 21.6 % of low-risk women received labor epidural analgesia in the whole world [2,3].…”