PARTURIENTS WHO PAY FOR PERINATAL EDUCATION CLASSES HAVE A HIGHER RATE OF LABOR NEURAXIAL ANALGESIA
Abstract Number: 99
Abstract Type: Original Research
Introduction: Analgesia for labor and delivery is an important part of the care of parturients. In the United States it is estimated that 60% of women choose neuraxial analgesia for pain relief during labor. Studies in the literature indicate that multiple variables affect whether parturients choose neuraxial analgesia for labor, including maternal age, parity, race, ethnicity, and education level. One study suggests that participation in childbirth preparation classes is a significant factor.1 Although such classes are available to pregnant women at many hospitals, the exact contents and emphasis vary even at the same institution depending on instructors or funding source. Since many women are poorly informed about the potential side effects of epidural analgesia, there are many common misconceptions about epidurals. More mothers may be exposed to childbirth through television shows than through childbirth education classes.2 Wider participation in childbirth preparation classes and content involving discussion of neuraxial analgesia for labor may help improve maternal understanding and request for such.
Methods: In this retrospective study, we reviewed electronic medical records and perinatal class rosters of parturients who delivered at Loma Linda University Medical Center over 6 months. We compared three different groups of parturients: Group A = parturients who attended a voluntary, paid, childbirth preparation class; Group B = parturients who attended an obstetrician-referred, free class; Group C = parturients who did not attend any childbirth class. Comparisons included the rate of neuraxial analgesia acceptance, education attained, ethnicity, and various maternal factors.
Results: The rate of labor neuraxial analgesia was statistically significantly higher in Group A (85.2%, P=0.04) than Group C (73.2%). There is a trend toward statistical significance in the labor neuraxial analgesia rate between Group A (85.2%, P=0.07) and Group B (71.7%). There is no statistical significance between Groups B and C (P=0.8).
Discussion: There are regional and hospital differences in maternal request rates. A study from upstate New York reported a 40% rate.3 The median labor epidural rate in a survey among the participating California hospitals was 65%, and in individual hospitals as high as 95%.4 Results of our study imply that patients who pay for childbirth preparation classes are more likely to receive epidural analgesia during labor. This may imply that the type of teaching makes a difference or that there is an economic component influencing their choice. Further analysis is ongoing to determine if there are any inter-group differences in factors such as maternal age, gestational age, gravidity, parity, cervical dilation on presentation, race, ethnicity, highest educational level attained, or marital status.
1 Anesth Analg 2000;90:109-13
2 J Perinat Educ. 2007;16:15-7
3 Anesthesiology 2007;106:19-25
4 Int J Obstet Anesth 2006;15:217-2