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Parameshwar P, Guo N, Bentley J, Main E, Singer SJ, Peden CJ, Morris T, Ansari J, Butwick AJ. Variation in Hospital Neuraxial Labor Analgesia Rates in California. Anesthesiology 2024; 140:1098-1110. [PMID: 38412054 DOI: 10.1097/aln.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Neuraxial analgesia provides effective pain relief during labor. However, it is unclear whether neuraxial analgesia prevalence differs across U.S. hospitals. The aim of this study was to assess hospital variation in neuraxial analgesia prevalence in California. METHODS A retrospective cross-sectional study analyzed birthing patients who underwent labor in 200 California hospitals from 2016 to 2020. The primary exposure was the delivery hospital. The outcomes were hospital neuraxial analgesia prevalence and between-hospital variability, before and after adjustment for patient and hospital factors. Median odds ratio and intraclass correlation coefficients quantified between-hospital variability. The median odds ratio estimated the odds of a patient receiving neuraxial analgesia when moving between hospitals. The intraclass correlation coefficients quantified the proportion of the total variance in neuraxial analgesia use due to variation between hospitals. RESULTS Among 1,510,750 patients who underwent labor, 1,040,483 (68.9%) received neuraxial analgesia. Both unadjusted and adjusted hospital prevalence exhibited a skewed distribution characterized by a long left tail. The unadjusted and adjusted prevalences were 5.4% and 6.0% at the 1st percentile, 21.0% and 21.2% at the 5th percentile, 70.6% and 70.7% at the 50th percentile, 75.8% and 76.6% at the 95th percentile, and 75.9% and 78.6% at the 99th percentile, respectively. The adjusted median odds ratio (2.3; 95% CI, 2.1 to 2.5) indicated substantially increased odds of a patient receiving neuraxial analgesia if they moved from a hospital with a lower odds of neuraxial analgesia to one with higher odds. The hospital explained only a moderate portion of the overall variability in neuraxial analgesia (intraclass correlation coefficient, 19.1%; 95% CI, 18.8 to 20.5%). CONCLUSIONS A long left tail in the distribution and wide variation exist in the neuraxial analgesia prevalence across California hospitals that is not explained by patient and hospital factors. Addressing the low prevalence among hospitals in the left tail requires exploration of the interplay between patient preferences, staffing availability, and care providers' attitudes toward neuraxial analgesia. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Pooja Parameshwar
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Bentley
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Elliot Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; and California Maternal Quality Care Collaborative, Stanford, California
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carol J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa Morris
- Department of Sociology, Texas A&M University, College Station, Texas
| | - Jessica Ansari
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Yao J, Roth H, Anderson D, Lu H, Rong H, Baird K. Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study. JMIR Res Protoc 2024; 13:e55701. [PMID: 38530330 PMCID: PMC11005428 DOI: 10.2196/55701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as "spontaneous pushing," which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. OBJECTIVE This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. METHODS A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). RESULTS Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives' interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. CONCLUSIONS This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women's childbirth experience. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55701.
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Affiliation(s)
- Jiasi Yao
- School of Nursing, Hebei Medical University, Shijiazhuang, China
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Heike Roth
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Debra Anderson
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| | - Huijuan Rong
- Department of Nursing, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Kathleen Baird
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Tascón Padrón L, Emrich NLA, Strizek B, Schleußner E, Dreiling J, Komann M, Schuster M, Werdehausen R, Meissner W, Jiménez Cruz J. Quality of analgesic care in labor: A cross-sectional study of the first national register-based benchmarking system. Int J Gynaecol Obstet 2024. [PMID: 38528775 DOI: 10.1002/ijgo.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. METHODS This prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. RESULTS A total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. CONCLUSION This study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women.
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Affiliation(s)
- L Tascón Padrón
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - N L A Emrich
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - E Schleußner
- Department of Obstetrics and Prenatal Medicine, University Hospital of Jena, Jena, Germany
| | - J Dreiling
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - M Komann
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - M Schuster
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Mainz, Mainz, Germany
| | - R Werdehausen
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - W Meissner
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - J Jiménez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Artieta-Pinedo I, Paz-Pascual C, Garcia-Alvarez A, Bully P, Espinosa M. Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth. BMC Womens Health 2024; 24:42. [PMID: 38225596 PMCID: PMC10789003 DOI: 10.1186/s12905-023-02856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics. METHODS The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability. RESULTS Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important. CONCLUSIONS Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain.
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain.
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Basque, Bizkaia, Spain.
| | - Carmen Paz-Pascual
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Midwifery Training Unit of Basque Country, Bilbao, Spain
| | - Arturo Garcia-Alvarez
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Bizkaia, Spain
| | - Maite Espinosa
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
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Kuipers PYJ, van Beeck E. Predictors associated with low-risk women's pre-labour intention for intrapartum pain relief: a cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100070. [PMID: 38745603 PMCID: PMC11080486 DOI: 10.1016/j.ijnsa.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design A cross-sectional online survey-based study. Setting and participants 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman's body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion Understanding the reasons predicting women's intention of pain management during labour, provides insight in low-risk women's supportive needs prior to labour and are worth paying attention to during the antenatal period.
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Affiliation(s)
- Prof. Yvonne J Kuipers
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
- Edinburgh Napier University, School of Health and Social Care, 9 Sighthill Court, Edinburgh EH11 4BN, Scotland, UK
| | - Elise van Beeck
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
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Women's perceptions of counselling on pain assessment and management during labour in Finland: A cross-sectional survey. Midwifery 2022; 114:103471. [DOI: 10.1016/j.midw.2022.103471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
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