Quality Epidurals for Labor: Are we getting it right?
Abstract Number: S-35
Abstract Type: Original Research
Introduction: Quality neuraxial labor analgesia (QNA) depends on the complexity of physical, cognitive and emotional factors interacting with the patient . As part of our 3rd study (Item Reduction) to cross-validate a quality of labor analgesia (QLA) index, we sought to determine if our epidural service met the “quality” expectations of this targeted patient population.
Methods: Following REB approval, native English-speaking postpartum women (ASA 1-2) who had received patient controlled neuraxial analgesia for labor and delivery were interviewed 27± hours of delivery. Exclusion criteria included preterm delivery (< 37 weeks), the administration of parenteral opioids ≤4 hours of neuraxial analgesia, maternal cognitive impairment or neonatal death during the current pregnancy. Trained interviewers, independent of patient care, administered a 57-item (True QLA) questionnaire describing factors previously identified as impacting on patients’ perception of QNA. In addition, participants self-completed a demographic survey which included SES, income and a priori plans and concerns related to epidural analgesia and their overall epidural analgesia on this occasion. Correlations between items were grouped under the relevant defined domains.
Results: A total of 186 eligible women participated. Most women were married (82%, 173/183), Caucasian (67%, 123/185), with university-level education (82%, 152/185) and household incomes greater than 100K (61%, 108/176). Five percent (9/183) stated they definitely did not want an epidural before onset of labor, and only one patient had midwife-provided obstetrical care. Forty two percent (79/186) were multiparous. Of this group, 89% (70/79) had an epidural with a previous pregnancy and 80% (56/70) felt pain relief was better or similar on this occasion. Concerns regarding epidural catheter placement, back pain, impact on breast feeding and risk of caesarean section were expressed by 77% (141/184), 60% (109/184), 18% ( 36/185) and 31% (58/185) of patients, respectively. Fifty-nine percent of women (107/181) felt overall control was better after epidural analgesia was initiated. Within the physical and cognitive dimensions of the QLA questionnaire, a positive correlation was found between overall QNA and pain relief (r=0.55,p<0.001), overall feelings of control (r=0.486, p<0.001) and ability to cope (r=0.54, p<0.001). Finally, 88% (162/185) would definitely recommend this modality of labor pain relief to their best friend, and 86% (159/184) would definitely have an epidural again.
Conclusion: From our patients’ perspectives, pain relief, control and ability to cope are important factors contributing to overall QNA and should be measured in assessing labor analgesia studies. Patients have ongoing concerns regarding epidural placement and risk of post-epidural back pain. The majority of women in our study indicated that they were receiving high quality neuraxial labor analgesia.