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Qualitative analysis of parturients' preferences for information on neuraxial analgesia
Abstract Number: F-51
Abstract Type: Original Research
Introduction: Hispanic and African-American patients are less likely than white patients to anticipate and use neuraxial labor analgesia. Previous work has demonstrated that Hispanic patients may have increased misunderstandings of the risk of neuraxial analgesia than non-Hispanic white women. The objective of this qualitative study was to evaluate the sources of information used by patients, the content of antepartum analgesic counseling, and patients’ preferences for analgesic counseling in a racial/ethnically diverse group of women.
Methods: An expert panel developed a semi-structured interview guide. Using stratified purposeful sampling; white, Hispanic, and African-American women were interviewed on postpartum day 1. Interviews were conducted in English and Spanish. Interviews were conducted until thematic saturation was achieved. Transcripts were transcribed verbatim. Responses were analyzed using content analysis. Two Spanish-speaking obstetric anesthesiologists developed an initial coding scheme, and the coding schemes were compared. A final coding scheme was developed and applied to all transcripts. Inter-rater reliability was 100%. Descriptive statistics were used to characterize counts and percentages.
Results: A total of 45 participants were interviewed. There were 15 white, 15 Hispanic, and 15 African-American women in the study.
The two most commonly used antepartum sources of information were obstetric providers and the Internet. Thirty-five of the 45 women had an antepartum discussion with their obstetric provider about analgesic options. Analgesic choices were discussed with 20 women, neuraxial analgesia alone was discussed with 9, and 6 women were only asked about their analgesic plans without any further discussion. These discussions occurred mostly in the 2nd and 3rd trimester of pregnancy. White women were the most likely to use the Internet as a source of information (47%), followed by African-American (34%), and Hispanic (19%) women.
All of the women were seen by an anesthesiologist intrapartum, yet this was not ideal for several patients. One patient stated, “When I was having the contractions and they were going over the side effects, I mean I was definitely listening… but you just kinda don’t care at that point.”
Thirty-three of the 45 women stated that they ideally would want counseling on analgesic options from their obstetrician, either in the 2nd or 3rd trimester (75% of respondents).
Conclusions: Our results indicate that patients receive and prefer to be counseled about labor analgesia by their obstetric providers before the onset of labor. Future work should evaluate obstetric provider knowledge and comfort with analgesic counseling.
Funding: RWJF 69779