Sticking to the Plan: Patient Preferences for Epidural Use During Labor
Author: Lauren Ann Gamble1, Ashley Hesson1, Tiffany Burns2.
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
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.
- Pilnick A, Dingwall R. On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review. Soc Sci Med 2011; 72: 1374-82.
- Simkin P. Birth plans: after 25 years, women still want to be heard. Birth 2007; 34(1): 49-51.
- Namey EE, Lyerly AD. The meaning of ‘‘control’’ for childbearing women in the US. Soc Sci Med 2010; 71(4): 769-76.
- Miller AC, Shriver TE. Women’s childbirth preferences and practices in the United States. Soc Sci Med 2012; 75(4):709-16.
- Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia_related preferences and outcomes of women who have birth plans. J Midwifery Women’s Health 2011; 56(4): 376-81.
- Horowitz ER, Yogev Y, Ben-Haroush A, Kaplan B. Women’s attitude toward analgesia during labor – a comparison between 1995 and 2001. Eur J Obstet Gynecol Reprod Biol 2004; 117(1): 30-32.
- Thompson R, Miller YD. Birth control: to what extent do women report being informed and involved in decisions about pregnancy and birth procedures? BMC Pregnancy Childbirth 2014; 14(1): 62.
- Toledo P, Sun J, Peralta F, Grobman WA, Wong CA, Hasnain-Wynia R. A qualitative analysis of parturients’ perspectives on neuraxial labor analgesia. Int J Obstet Anesth 2013; 22(2): 119-23.
- Fro¨ hlich S, Tan T, Walsh A, Carey M. Epidural analgesia for labour: maternal knowledge, preferences and informed consent. Irish Med J 2012; 104(10): 300-2.
- Pain relief during labor. ACOG committee opinion No 295. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004; 104: 213.
- Johnson DE. Getting off the GoldVarb standard: introducing Rbrul for mixed-effects variable rule analysis. Lang Linguist Compass 2009; 3: 359-83.
- R Development Core Team. R: A language and environment for statistical computing [Computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2012.
- Hadar E, Raban O, Gal B, Yogev Y, Melamed N. Obstetrical outcome in women with self-prepared birth plan. J Matern Fetal Neonatal Med 2012; 25(10): 2055-7.
- Hidaka R, Callister LC. Giving birth with epidural analgesia: the experience of first-time mothers. J Perinat Educ 2012; 21: 24.
- Kannan S, Jamison RN, Datta S. Maternal satisfaction and pain control in women electing natural childbirth. Reg Anesth Pain Med 2001; 26(5): 468-72.
- Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186(5): S160-72.
- Lawrence HC III, Copel JA, O’Keeffe DF, Bradford WC, Scarrow PK, Kennedy HP, et al. Quality patient care in labor and delivery: a call to action. Am J Obstet Gynecol 2012; 207: 147-8.