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Women’s Preferences for Analgesia Outcomes Associated with Labour Epidurals
Abstract Number: T210-318
Abstract Type: Original Research
Labour epidural analgesia (LEA) is an important part of childbirth for women undergoing vaginal deliveries. However, women’s preferences for LEA outcomes has been incompletely evaluated.
To determine women’s preferences for LEA outcomes and whether they differ between antenatal and postpartum women.
This prospective cohort study was approved by the institutional ethics board. Questionnaires were distributed to two cohorts screened for eligibility: pregnant women (≥ 24 weeks gestation) at an antenatal visit and postpartum women during their childbirth admission. Common LEA outcomes were compiled using research published in leading anesthesia journals from June 2016 – May 2018. The list was appraised by two obstetric anesthesiologists to evaluate content validity. Volunteer patients, anesthesiologists and obstetricians reviewed the questionnaire for face validity. Participants ranked the outcomes according to perceived importance. They assigned each a number from 1 to 10 (priority ranking; 1 indicated the highest priority outcome and 10 the least). They also ‘spent’ $100 towards the outcomes (relative value scale), allocating more money to outcomes more important to them. Lastly, they were questioned (1 to 10 numeric ranking scale) regarding LEA expectations (antenatal) or satisfaction (postpartum).
There were 220 questionnaires completed, 105 in the antenatal group and 115 in the postpartum group. The groups were not significantly different in terms of demographics. Achieving desired pain relief was the most important outcome for both groups. It was valued significantly more by the postpartum group who gave it an average of $46, while the antenatal group gave it an average of $35 (P=0.004). Postpartum women ranked 'experiencing a short time to achieve pain relief’ as more important compared to antenatal women (Avg 5.2 vs. 3.8 (P<0.001)). Results for all outcomes are outlined in Table 1. The postpartum group reported more LEA satisfaction than the antenatal group indicated they were expecting (Avg 8.9 vs. 8.3 (P=0.004)). While both groups expected/experienced the same level of pre-epidural pain, the postpartum group experienced less post-epidural pain than the antenatal group expected (Avg 3.0 vs. 4.1 (P<0.001)).
Achieving desired level of pain relief and overall satisfaction with pain management was the greatest concern for women. Side effects such as leg weakness and pruritus were only mildly concerning.