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Experiences with Labor Epidural Analgesia: A Qualitative and Quantitative Analysis
Abstract Number: T-28
Abstract Type: Original Research
Most women who give birth in U.S. hospitals receive neuraxial analgesia to manage pain during labor. This analysis used both quantitative and qualitative methods to characterize women using epidural analgesia (EA) and to examine themes of the patient experience of EA among a national sample of U.S. mothers.
Data are from the Listening to Mothers II survey, conducted among a nationally representative sample of women who delivered a singleton baby in a U.S. hospital in 2005 (N=1,573). We examined the association of EA use with maternal characteristics and obstetrical/clinical factors using multivariate logistic regression. We also analyzed open-ended responses about the best and worst parts of women’s birth experiences for themes related to EA.
Seventy-four percent of women in the sample used EA. Factors associated with higher odds of EA use were private insurance (vs. public, Adjusted Odds Ratio [AOR] 2.03; 95% Confidence Interval [CI] 1.29, 3.20), residence in the West census region (vs. Northeast, AOR 2.19; 95% CI 1.18, 4.05), previous cesarean delivery (AOR 3.59, 95% CI 1.19, 10.88), oxytocin use (AOR 2.55; 95% CI 1.70, 3.83), and labor induction (AOR 1.61; 95% CI 1.07, 2.43). Multiparous women and women who believed that birth was a process that should be minimally interfered with had lower odds of EA use.
In the qualitative analysis, we found that effective pain relief from EA was frequently reported as a positive aspect of their birth experience. Many women perceived timing-related challenges with EA, including waiting in pain for EA, receiving EA too late in labor, or feeling that the pain relief from EA wore off too soon. Other important themes in women’s experiences with EA were information and consent, adverse effects of EA, and plans and expectations.
Findings from the qualitative analysis underscored the fact that women appreciate the effective pain relief that EA can provide during childbirth. The quality of women’s birth experiences is affected by their level of pain control, but also by other factors over which clinicians have some degree of influence. Anesthesiologists can work with obstetric clinicians, nurses, childbirth educators, and with pregnant and laboring patients to help mitigate some of the challenges with timing, communication, EA administration, or expectations that may have contributed to negative aspects of women’s birth experiences.