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Survey of Attitudes and Perceptions of Nulliparous Parturients Regarding Labor Epidural Analgesia
Abstract Number: T-28
Abstract Type: Original Research
INTRO: At our hospital, more than 90% of nulliparous parturients receive labor epidurals, but we have noticed that many women experience considerable pain before requesting their epidural. We posited a link between this delay and misconceptions about epidurals. We therefore conducted a survey to probe parturient attitudes and perceptions.
METHODS: Laboring nulliparous women with epidurals were enrolled. Questions included pain (VAS; 0 - 10) before and after the epidural, the influence of painful contractions on the parturient’s decision to plan for an epidural, attendance at a childbirth education class, and perception of class bias regarding epidurals. We also assessed 12 specific factors (listed on the x axis in the figure below) that may have influenced the decision to request an epidural.
RESULTS: 150 surveys were completed. Although we did not track response rate for the first 100 surveys completed, we did so for the next 50 completed (response rate = 96%). Pain VAS declined from 7.1 (2.1 SD) before to 0.7 (1.0 SD) after epidural (p<0.01 Wilcoxon signed rank test). Intention to plan for epidural before and after painful contractions began increased from 72% to 89.3% (p <0.01; McNemar’s test). 67.3% of respondents attended a childbirth class. Perception of class bias was 15.4% pro-epidural, 51.2% neutral, and 27.5% anti-epidural. See figure 1 for breakdown of the 12 specific factors probed. The most common factors driving decision-making about epidurals were that the epidural should not be taken too early (68.6%), that it would slow labor (66%) and that parturients wanted to test their pain tolerance (66.6%). 49.3% of women were fearful of the epidural procedure. 30% and 18.7% thought that epidurals would increase their risk of cesarean and vacuum/forceps, respectively. Childbirth class attendance increased the odds of thinking that the epidural should not be taken too early (OR=2.5; 95% CI: 1.2 to 5.1; p=0.013) and that the epidural would slow down labor (OR=2.3; 95% CI: 1.1 to 4.7; p=0.02).
DISCUSSION: We found that many nulliparous women harbor misconceptions about epidural analgesia, which are not supported by evidence-based medicine. Attending childbirth class appears to encourage women to delay their request for epidural analgesia. We suggest that efforts be directed towards providing mothers-to-be with accurate evidence-based information, so that they will better able to decide if and when to request epidural analgesia for their labor.