Risk factors associated with epidural use

The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series

Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; p < 0.001) and CS delivery rate (26% versus 10.1%; p < 0.001). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51–5.24; p < 0.001). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors.

Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women

BACKGROUND

Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use.

OBJECTIVE

Examine the determinants associated with women's use of labour pain management.

DESIGN

Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH).

SETTING AND PARTICIPANTS

Women aged 31-35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).

MAIN VARIABLES STUDIED

Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants' attitudes and beliefs related to both CAM and maternity care were also included in the analysis.

MAIN OUTCOME MEASURES

The outcome measures examined were the use of both pharmacological and non-pharmacological pain management techniques (NPMT).

RESULTS

Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS).

DISCUSSION AND CONCLUSIONS

The effect of key determinants on women's use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options.