Satisfaction, control and pain relief: short- and long-term assessments in a randomised controlled trial of low-dose and traditional epidurals and a non-epidural comparison group
Accepted 4 May 2009. published online 30 November 2009.
Abstract
Background
Childbirth is an important life event for which a positive experience is important to many women.
Methods
As secondary outcomes from the randomised controlled Comparative Obstetric Mobile Epidural Trial, various aspects of satisfaction were assessed in women who had one of three types of regional analgesia (two of which were low-dose techniques and a high-dose control using 0.25% epidural bupivacaine) and a comparison group who did not have epidural analgesia, shortly after delivery and 12 months later.
Results
The predominant finding was satisfaction with spontaneous vaginal delivery whatever the mode of analgesia. The overall immediate and long-term satisfaction was similar for all three neuraxial techniques. Satisfaction with the speed of pain relief and the amount of mobility were significantly greater for the combined spinal-epidural technique compared with the low-dose infusion (P<0.001). The degree of control felt by women who had combined spinal-epidural analgesia was greater than with the high-dose (P<0.05). Women in the non-epidural comparison group did not report a greater feeling of control. Among those who delivered spontaneously, more women in the combined spinal-epidural group (30%) felt in full control compared with the high-dose group (17%) (P<0.05). By comparison 22% in the low-dose infusion group and only 15% who had no epidural felt in full control.
Conclusions
Whilst satisfaction with the experience of childbirth appears intimately related to the attainment of a spontaneous delivery, mobile epidurals enhance women’s feeling of control in labour and are popular for future choice of regional analgesia.
aDepartment of Anaesthesia, Birmingham Women’s Hospital
bDepartment of Epidemiology and Public Health, University of Birmingham
cDepartment of Anaesthesia, Royal Hallamshire Hospital, Sheffield
dDepartment of Reproduction and Endocrinology, Kings College London, St. Thomas Hospital, London, UK
Correspondence to: Dr Griselda Cooper, Department of Anaesthetics, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK. B15 2TH. Tel.: +44 121 627 2060.
Presented in part at the Society for Obstetric Anesthesiology and Perinatology Annual Scientific Meeting, Phoenix, Arizona, USA, May, 2003.
ABSTRACT