Parturients’ Stated Preferences for Labor Analgesia: A Discrete Choice Experiment

Abstract

Objective The objective was to investigate the extent to which treatment benefits, risks and costs affected parturients’ preferences for labor analgesia. Methods We recruited 248 healthy parturients prior to labor at an antenatal ward and administered a discrete choice experiment survey. Parturients were asked to choose among four hypothetical forms of labor analgesia: epidural analgesia, pethidine, Entonox and no analgesia, which were defined by: pain score, duration of second stage of labor, risks of instrumental delivery, back pain and permanent nerve injury, and out-of-pocket cost. We used mixed logit model to calculate the relative importance of each attribute (out of 100). Results Parturients preferred receiving labor analgesia over not receiving analgesia and those who had positive past experience with epidural preferred epidural over other modalities. Out-of-pocket cost (28%), duration of second stage of labor (26%) and pain score following treatment (18%) were the most important attributes. Conclusion Out-of-pocket cost was a major concern. Parturients prioritized having lower pain and shorter labor experience over risks associated with epidural analgesia. Parturients should be presented with realistic range of risks of side-effects so that they can decide how to balance risks against benefits and costs associated with child labor.

Knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at UNIOSUN Teaching Hospital (UTH), Osogbo, Osun State

“…Fear of side effects and cost were the commonest reasons cited for decline this procedure in our trial. This is like findings relatively more affluent 16,17 countries . This is surprising considering that over 80% of our subjects had tertiary education which should ideally translate to higher earning power.…”

Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries

“…The choice of analgesic technique during labor and subsequent anesthetic management for intrapartum cesarean delivery (CD) is a complex decision influenced by diverse factors. These include patient preferences (e.g., prior experience, pain perception, concerns about nerve damage), anesthesia-related considerations (e.g., indications and contraindications), obstetric circumstances, fetal well-being, and other clinical factors [41]. Thus, it is imperative to recognize that the choice of anesthesia is not solely a consequence of preexisting labor analgesia but rather a complex and carefully considered decision aimed at optimizing the outcome for both the parturient and the neonate.…”