Epidural analgesia during labor: Attitudes among expectant mothers and their care providers

Garg, Kamakshi; Grewal, Anju; Tania, Singh; Priyanka, G; Kamya, Bansal; Gegal, Pruthi; Chuttani, P. N.

doi:10.4103/aer.aer_48_18

Cited by 16 publications

(13 citation statements)

References 5 publications

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“…The use of epidural anesthesia is not universal around the World. In India for example the knowledge, attitude, and practice regarding epidural anesthesia among parturient women are different [ 39 ]. Kamakshi found that about 33% of the participants knew that delivery is possible without pain, but only 18% were satisfied with the procedure.…”

Section: Discussionmentioning

confidence: 99%

Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China

Liu

Guo

et al. 2021

BMC Pregnancy Childbirth

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Background Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women’s experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience. Methods The study is a cross-sectional survey of 4192 women who had natural birth from March–June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women’s experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used. Results In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes’ postpartum guidance. Negative satisfaction was seen with perineal pain and edema. Conclusion Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.

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Section: Discussionmentioning

confidence: 99%

Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China

Liu

Guo

et al. 2021

BMC Pregnancy Childbirth

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“…There is a known gap between the desire for labor using analgesia and its availability as well as poor knowledge about epidural analgesia among women. This can also lead to its low utilization during labor 26 …”

Section: Discussionmentioning

confidence: 99%

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

Souza

Cecatti

Guida

et al. 2020

Intl J Gynecology & Obste

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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.

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“…Negative experiences were reported by women in regard to miscommunication with care providers with lack of empathy from the clinicians, late provision of epidural analgesia due to anaesthetist availability and subsequent ineffective analgesia during the second stage of labour (Attanasio et al., 2015). Timely epidural anaesthesia may not always be provided due to service and anaesthetist availability (Kamakshi et al., 2018). For women to be empowered in their pain relief decision‐making, midwives need to provide ‘open communication, adequate life skills, a nurturing and caring environment and a democratic management structure’ (Too, 1996:44).…”

Section: Discussionmentioning

confidence: 99%

Mixed‐methods systematic review: Childbearing women's views, experiences, and decision‐making related to epidural analgesia in labour

Borrelli

Evans

Pallotti

et al. 2020

Journal of Advanced Nursing

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Aims To investigate childbearing women's views, experiences and decision‐making related to epidural analgesia in labour. Design Mixed‐methods systematic review. Data Sources A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected. Results Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent. Review Methods Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE‐CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed‐methods synthesized findings was produced. Conclusion Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth. Impact The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision‐making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high‐income countries.

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Epidural analgesia during labor: Attitudes among expectant mothers and their care providers

Cited by 16 publications

References 5 publications

Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China

Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China

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

Mixed‐methods systematic review: Childbearing women's views, experiences, and decision‐making related to epidural analgesia in labour

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