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Why is labor epidural rate low and cesarean delivery rate high in China? A Survey of Chinese Perinatal Care Providers
Abstract Number: SA-44
Abstract Type: Original Research
Background: The cesarean delivery (CD) rate in China is as high as 50% (1). One of the reasons is patient request for CD due to the fear of labor pain. Neuroaxial analgesia (NA), an approved safe method to lower CD (2), is not widely provided or used in China (3). Opinions on NA and CD were investigated for better solutions.
Methods: An online survey was conducted for 2 months. Responses were collected and presented as percentages. Chi-square is used for comparisons.
Main Results: A total of 1412 respondents including 43% anesthesiologists (ANs), 35% obstetricians (OBs), 12% midwives, 4% L&D nurses, 2% hospital administrators (HAs) and 4% unspecified completed survey for analysis. Three main groups, AN, OB and midwives/L&D nurses (MN) are chosen for comparisons.
Opinions on length of stages of labor were divided between ANs and the other two groups that have almost same percentage of answers. A similar pattern was found regarding lower back pain and baby wellbeing. MNs concern more than OBs as shown in the sum of answers “yes” and “uncertain”. Positively, 60% and 77% of respondents, respectively, answered “no” to each question. Respiratory depression is the top concern for neonates (11% of 1412), followed by “uncertain” (3.0%), brain (1.5%), breastfeeding (1.2%), and heart (0.5%) (Table 1).
In table 2, All three groups agreed the low NA rate is related to: 1) lack of ANs (60%, confirmed in Q9 with 80% of suggesting to hire more ANs) or midwives (32%, 63% of suggesting to increase in hiring in Q9); 2) unwillingness of family members (26%), ANs (25%) or parturient (18%) (Q6). However, when comparing the answers from each group, ANs thought it is related to OB’s reluctance (44%) and higher incentive of CD (19%, confirmed by Q 7 with 20%); OBs believed no harm of CD to mothers (13% in Q 7), lack of NA experience (9.9%), and ineffective NA (9.1%). The MNs concern more about NA complications (8.0%) or harm to fetus (5.0%). All providers do believe that high CD rate is related to: 1) no long term complications in mothers, 2) no harm to babies; 3) culture; 4) malpractice (Q7). Most are willing to provide NA even with low income (Q8).
Summary: This is the first national multidisciplinary survey for NA and CD, specially seeking solutions conducted by NPLD – GHI. It provides lots of information for policy makers, HAs, medical societies, and department leaders to improve clinical practice and management, and may be useful for other developing countries.