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FACTORS INFLUENCING USE OF NEURAXIAL LABOUR ANALGESIA

Departments of Anesthesia, Obstetrics & Gynecology and Nursing, Sunnybrook & Women’s College HSC, 76 Grenville Street, Toronto, ON, M5S 1B2, University of Toronto; Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, 3650 Bathurst Street, Toronto, ON, M6A 2E1; Dept of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8; Dept of Anesthesia, Toronto East General Hospital, 825 Coxwell Ave, Toronto, ON, M4C 3E7; North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1

INTRODUCTION: Little is known about parturient decision-making related to use of neuraxial analgesia (NA) for labour. We report preliminary research examining sources of information and concerns experienced related to NA prior to its use. Information was gathered during development of the Quality of Labour Analgesia Index.

METHODS: Qualitative descriptive methods were used to explore sources of information used related to NA and concerns at the time of epidural placement. After REB approval, a purposeful sample of English speaking parturients (mixed parity, racial, socioeconomic status, delivery mode) was recruited from 1 teaching and 2 community urban hospitals with a combined delivery rate of >10,000/year. All women received NA (readily available in all hospitals). Focus groups and in-depth interviews were held during hospitalization 72 hours of delivery. A semi-structured interview guide was used to explore information sources and concerns related to NA with further iterative exploration until response saturation was achieved. Thematic content analysis was performed. Emergent themes related to factors influencing women’s decisions to use NA.

RESULTS: 27 parturients were interviewed (5 focus groups;14 in-depth interviews). Preliminary results suggest a complex dynamic interaction between major themes influencing the decision to use NA. Themes included: pain, past experience, self-image, fear (related to pain and/or NA side-effects/complications); information provided (past and present) by women’s key informants (lay and professional), and personal labour support. Key concerns included: paralysis, nerve damage, long term back pain, effects on labour progress, participation in the birth experience, sitting still for the procedure, drug side-effects; safety (neonatal and maternal) and fear of having to wait for pain relief. Primiparous women were usually concerned over the risk of paralysis, nerve injury and backpain. Multiparous women with a history of uneventful NA were more likely to have few concerns and voiced fear of having to wait for analgesia. Dissatisfaction/frustration was voiced over the lack of accurate information (usually negative) available in communities and from some health care providers relating to NA.

DISCUSSION: Research findings suggest a complex dynamic process involved in parturients’decision making related to use of NA for labour and post-analgesia frustration related to the lack of accurate information provided by key informants.

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