The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

Abstract

Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change of overall cesarean delivery(CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia was initiated in May 1st 2015. A multidisciplinary NPLD team from America was invited to our hospital to give education and training for 7 days. After training, the application of neuraxial labor analgesia became a routine operation in our hospital, and every parturient can choose to use neuraxial analgesia or not according to her own requirement. The rates of neuraxial labor analgesia(NA), CD, MRCD, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 ( p< 0.001); the rate of CD decreased from 50.4% in May 2015 to 36.3% in April 2016 (, p< 0.001); the rate of MRCD decreased from 10.8%in May 2015 to 5.7% in April 2016( p< 0.001). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951,-0.642], p =0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971,-0.497], p =0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in vaginal delivery women and the rates of intrapartum CD, neonatal asphyxia, and PPH in CD women remained unchanged from May 2015 to April 2016.Conclusions Our study shows that the rates of CD and MRCD in our department significantly decreased over a year period(2015 05~2016. 04), which may be due to the increasing use of NA during vaginal delivery.