An Impact Study of No Pain Labor N’ Delivery on Labor Analgesia Rate and Obstetric Outcomes in a Chinese Academic Hospital

Abstract Number: T 10
Abstract Type: Original Research

Ling Qun Hu MD1 ; Mingpin Hu MD, BS2; Qingquan Lian MD, PhD3; Cynthia A Wong MD4; Robert McCarthy PharmD5; Jeffry Chen MD6
Northwestern University1 ; The Second Hospital of Wenzhou Medical College2; The Second Hospital of Wenzhou Medical College3; Northwestern University4; Northwestern University5; Northwestern University6

Introduction: Labor analgesia pain management varies widely in China with <1% of women receiving neuraxial analgesia (NA). The No Pain Labor N' Delivery (NPLD) cooperative program was launched in China in 2008. We have previously reported a positive impact, including a lower cesarean delivery rate, of initiating an NA service in a community maternity hospital. In the current study we report the impact of NPLD on NA rate and obstetric practice in an academic center.
Methods: This study reports outcomes from The Second Hospital of Wenzhou Medical College between Jan 2009 and June 2011. The staffing of obstetric service remained constant. The NA service started in July 2009 (Mon-Fri 0800-1730) and became 24/7 on May 2010. Prior to initiation of the service no pharmacologic pain management was used during labor. NPLD training was conducted in June 2010. Clinical outcomes included the mode of delivery (primary outcome), total number of obstetric clinic visits, obstetric admissions, total deliveries, indications for cesarean delivery (CD), and traumatic vaginal deliveries (episiotomies and third-fourth degree lacerations). The study period was divided into 3 phases, baseline(1/2009–6/2009), phase-in(7/2009–5/2010), post-NPLD(6/2010–6/2011). Data were compared between the baseline and the post-NPLD phases and between the early post-NPLD(6/2010–8/2010) and late post-NPLD(4/2011–6/2011). Data were analyzed using χ2 and t-test. P < 0.01 was considered significant.
Results: There were 15,415 deliveries in the study period. Outcomes are shown in the Table. There was a significant increase in NA rate, overall deliveries, vaginal deliveries, clinic visits and admissions along with decreases in the rates of the overall CD, non-medically indicated CD, and traumatic vaginal deliveries between the baseline and the post-NPLD periods. The rates of forceps deliveries and intrapartum CD deliveries remained unchanged. Analysis of early versus late post-NPLD periods demonstrated sustained clinical outcomes for one year after the NPLD program.
Conclusion: Following NPLD, NA increased and the rates of CD and traumatic vaginal childbirths decreased without an increase in operative deliveries in both modes. Increases in clinic visits, admissions, and overall deliveries suggest improved efficiency in clinical practice. The outcomes were sustained for at least one year. Our findings suggest that NPLD has changed obstetric practice with improvements in labor and delivery outcomes.

SOAP 2013