Winter 2015 – Sticking to the Plan: Patient Preferences for Epidural Use During Labor

Sticking to the Plan: Patient Preferences for Epidural Use During Labor

Author: Lauren Ann Gamble1, Ashley Hesson1, Tiffany Burns2.

Author Affiliations:

1College of Human Medicine, Michigan State University, East Lansing, MI, USA

2Department of Family Medicine, Michigan State University, East Lansing, MI, USA

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Corresponding Author: Lauren Ann Gamble, gambleL2[at]msu.edu

Key Words: epidural; birth plan; labor analgesia; patient preference, decision making.

Abstract: Background: Women have been shown to value control in the labor experience, a desire that is often formalized into an explicit birth plan. Epidural preferences are a primary component of this plan. Despite this specification, women’s plans are not always carried out. This may be due to patient factors (e.g., dissatisfaction with labor), provider behaviors (e.g., frequent epidural offers), or situational variables (e.g., prolonged labor). Purpose: The current study investigates the relative impact of patient preference for epidural use as compared to provider suggestion and circumstances of labor. It hypothesizes that providing an epidural preference in a birth plan and receiving frequent epidural offers will predict epidural administration. Methods: Adult, postpartum women were surveyed about their labor experience at a high-volume obstetrics unit in a medium-sized community hospital. Responses to a structured survey instrument focused on prelabor preferences and labor characteristics. Descriptive statistics and multiple logistic regression modeling were used to analyze participant responses. Results: Eighty-three postlaboring women completed surveys, of which 79 surveys were analyzed. Eighty-four percent (N_66) received an epidural during their labor process, while 73% (N_58) desired an epidural as a part of their birth plan. Women were offered an epidural at a mean frequency of 0.2790.48 times per hour (median_0.14). The significant predictors of epidural administration were desire for an epidural in the birth plan (pB0.01) and the frequency of epidural offers (pB0.01). Wanting an epidural was associated with receiving an epidural. Conversely, increased frequency of being offered an epidural negatively correlated with epidural administration. Conclusions: Our findings indicate that personal preference is the most influential factor in determining whether or not a laboring woman will receive an epidural. Increasing provider attempts to offer an epidural – as represented by increased frequency of queries- decreased the likelihood that an epidural would be received.

Published on date: January 1, 2015

Senior Editor: Tina Chaalan

Junior Editor: Jennifer Monacelli

DOI: Pending

Citation: Gamble LA, Hesson A, Burns T. Sticking to the Plan: Patient Preferences for Epidural Use During Labor. Medical Student Research Journal. 2015;4(Winter):59-65.

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Jessica Wummel

Executive Editor
Jessica Wummel is a third year medical student at Michigan State University’s College of Human Medicine. She received her B.S. in Human Biology with a specialization in Bioethics, Humanities, and Society also from Michigan State University in 2011 from the Lyman Briggs College. She is interested in pursuing a career in Med/Peds and would eventually like to be involved in academic medicine later in her career.