Application of epidural analgesia in obstetric hospitals of Ukraine and its alternative

Abstract

Epidural analgesia (EA) provides the most effective labor analgesia, however, it significantly affects the process of childbirth, so finding out the true frequency of adverse outcomes in the case of EA during vaginal birth is relevant.The objective: to establish the frequency of use of EA in maternity healthcare institutions of Ukraine, to determine the relationship between the development of adverse perinatal outcomes in women with vaginal births and use of EA, and the introduction of alternative methods of analgesia for vaginal births.Materials and methods. The frequency of adverse outcomes was analyzed in the group of women who had a vaginal birth and who did not use EA (n=27 503) and in the group of women who had a vaginal birth with EA (n=22 214). The frequency of EA use in vaginal births in 2023 was studied during premature births at 22–25 weeks of pregnancy, 26–32 weeks and 32–37 weeks, pregnancies with preeclampsia, diabetes, breech presentation of the fetus, and the presence of a uterine scar.The data of the medical records of the electronic health care system of women who had vaginal births during 2023 served as the information base. Bibliosemantic, analytical, epidemiological, statistical and conceptual research methods were used.Results. The use of EA is a common method of analgesia for childbirth in Ukraine. EA during childbirth significantly increases the chances of a woman having a prolonged labor (odds ratio (OR) 4.71; p<0.001), weakness of labor (OR 3.52; p<0.001), stimulation of labor (OR 2.36; p< 0.001), instrumental vaginal births (OR 2.76; p<0.001), rupture of the perineum of the 2nd degree (OR 1.24; p<0.001), cervical rupture (OR 1.15; p=0.011), vaginal rupture (OR 1.17; p<0.001), episiotomy (OR 1.71; p<0.001), delayed separation of the placenta (OR 1.32; p<0.001) and fetal distress (OR 1.8; p<0.001).An alternative to EA can be effective non-pharmacological pain management (NРPM), which has numerous advantages in terms of the absence of complications. Effective implementation of NPPM in practice requires the development of a comprehensive approach, including improved education and support for women, availability of resources, and promotion of dissemination of knowledge about NPPM among health care providers.Conclusions. In the study, reliable results were obtained regarding a higher frequency of adverse outcomes in women who received EA compared to women who did not receive EA, namely: prolonged labor, weakness of labor, stimulation of labor, instrumental vaginal delivery, second-degree perineal rupture, cervical rupture, vaginal rupture, episiotomy, delayed separation of the placenta, and fetal distress.These results indicate the need for a balanced approach to the use of EA, based on the benefits and risks for the woman and the fetus. The use of NPPM is a promising alternative that potentially improves the birth experience, reduces adverse effects, and improves outcomes for both mothers and newborns.These methods use the natural pain-relief mechanisms of the organism and promote relaxation, comfort, reduced anxiety, and increased labor satisfaction. In addition, their use has a minimal number of side effects and risks, which makes them an attractive option for most women.