Epidural use among women with spontaneous onset of labour - an observational study using data from a cluster-randomised controlled trial

Factors influencing the choice of lumbar epidural analgesia and its association with postpartum depression risk

BACKGROUND

The use of lumbar epidural analgesia (LEA) during childbirth varies significantly among women. Factors influencing a woman's choice of LEA and its possible effects on postpartum depression (PPD) remain underexplored.

OBJECTIVES

To investigate factors influencing the choice of LEA among women with intended vaginal deliveries. A secondary objective was to explore the association between LEA use and PPD.

STUDY DESIGN

A longitudinal cohort study.

SETTING

Uppsala University Hospital, Sweden, 2010 to 2019.

POPULATION

Women with an intended vaginal delivery.

EXCLUSIONS

Twins, elective caesarean section, induction of labour.

METHODS

Data were collected by web-based self-completed questionnaires at gestational weeks 17, 32 and at 6 weeks and 6 months postpartum. The exposures were sociodemographic, resilience-related, medical and obstetric characteristics of all participants from the BASIC (Biology, Affect, Stress, Imaging and Cognition) study. Information on the use of LEA was retrieved from medical records. PPD was assessed using either the Edinburgh Postnatal Depression Scale, or the Depression Self-Rating Scale, and/or the Mini-International Neuropsychiatric Interview at 6 to 8 weeks and 6 months postpartum. Bayesian models were applied to investigate the associations of multivariate factors with the choice for LEA, and the association between the use of LEA and PPD.

RESULTS

Among 4436 participants, 38% opted for LEA, while 62% did not. LEA users were younger, primiparous, reported higher rates of intimate partner violence (IPV) and had lower resilience. The adjusted model revealed primiparity, previous caesarean section, IPV, pregnancy length at least 280 days and fear of childbirth as independent predictors of LEA use. While LEA use was associated with higher odds of PPD in the crude regression model, it was no longer statistically significant after adjusting for possible confounders and mediators.

CONCLUSION

Social and psychological vulnerabilities influence a woman's decision to opt for LEA during childbirth. LEA was not associated with PPD in adjusted models.

TRIAL REGISTRATION

This is a longitudinal study which was not registered back in 2010.

Birth outcomes associated with a natural delivery approach in a perinatal center: A comparative retrospective study

OBJECTIVES

At our center, natural home-like delivery settings have been established in or near conventional labor wards, for the care of pregnant women who prefer little or no medical intervention during labor and birth. We compared obstetrical and neonatal outcomes of women in active spontaneous labor, between those who chose to deliver in a natural-delivery setup and those who chose a conventional setting.

METHODS

This retrospective study included low-risk women who delivered at term between March 1, 2020 and December 31, 2022, in a single tertiary university affiliated medical center. Birth outcomes were compared between 124 women who delivered by natural birth (the study group) and 244 who gave birth in a conventional setting (the control group).

RESULTS

No cesarean deliveries were performed in the study group, compared to 18 (7.4%) of the control group, p = 0.004. Intrapartum fever, postpartum hemorrhage, and uterotonic administration were similar between the groups. For the study compared to the control group, breastfeeding was more common (71.3% vs. 12.3%, p < 0.001), analgesia administration within 48 h delivery was lower (4.1% vs. 10.7%, p = 0.033), and maternal and neonatal length of hospitalization were shorter. Of the women initially admitted to the natural-delivery room, 14 (11.5%) were transferred to a conventional-delivery room.

CONCLUSIONS

Birth in a hospital natural-delivery setting was associated with increased likelihood of vaginal birth, increased immediate breastfeeding and breastfeeding at discharge, and lower postpartum pain.