Parturient satisfaction with labour epidural and factors affecting satisfaction scores: experiences from a tertiary centre in Southern India
Keywords:Epidural analgesia, Labour analgesia, Patient satisfaction, Satisfaction scores
Background: Labour analgesia though widely practised is still not routinely administered to all parturients in India. We conducted this historical observational cross-sectional study to assess parturient knowledge and factors affecting satisfaction in those who received epidural labour analgesia; aiming at improving the services.
Methods: All parturients requesting epidural labour analgesia have the catheter sited and the drug administered as per institutional protocols. A feedback form is given to these parturients, postnatally. The form consists of questions regarding her knowledge of and experience with labour analgesia, including her satisfaction score on a scale of 0 to 10. Author collected these forms and analyzed them along with information from the labour epidural register and the discharge summary.
Results: The mean satisfaction score was 7.1 (SD- 2.28). 46 parturients (31.08%) had ‘low satisfaction’ (<7 score) and 102 parturients (68.9%) had ‘high satisfaction’ (≥7 score). The timing of initiation of epidural analgesia within the parturients expectations and adequate analgesia were two factors that were found to affect satisfaction scores, with statistically significant values (p=0.002 and p=0.006 respectively). Those with a very short or very long duration of labour analgesia, were more likely to give less satisfaction scores (p=0.023 and p=0.002). Only 30% of parturients had heard of labour analgesia in the past.
Conclusions: In this setting good analgesia and receiving it on time are of utmost importance in those receiving epidural labor analgesia, emphasising the need for adequate analgesia and prompt initiation of the same.
Dunn PM. Sir James Young Simpson (1811-1870) and obstetric anaesthesia. Arch Dis Child - Fetal Neonatal Ed. 2002;86(3):F207-9.
Bhatt H, Pandya S, Kolar G, Nirmalan PK. The impact of labour epidural analgesia on the childbirth expectation and experience at a tertiary care center in Southern India. J Clin Diagn Res JCDR. 2014;8(3):73-6.
Bhattacharyya S, Srivastava A, Avan BI. Delivery should happen soon and my pain will be reduced: understanding women’s perception of good delivery care in India. Glob Health Action. 2013;6:22635.
Kamakshi G, Anju G, Tania S, Priyanka G, Kamya B, Gegal P, et al. Epidural analgesia during labor: attitudes among expectant mothers and their care providers. Anesth Essays Res. 2018;12(2):501-5.
Samanta S, Jain K, Bhardwaj N, Jain V, Samanta S, Saha R. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies. Indian J Anaesth. 2016;60(2):115.
Richardson MG, Lopez BM, Baysinger CL, Shotwell MS, Chestnut DH. Nitrous oxide during labor: maternal satisfaction does not depend exclusively on analgesic effectiveness. Anesth Analg. 2017;124(2):548-53.
Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S160-172.
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.
Camann W. Pain, pain relief, satisfaction and excellence in obstetric anesthesia: a surprisingly complex relationship. Anesth Analg. 2017;124(2):383.
Kekre AN, Vijayanand S, Dasgupta R, Kekre N. Postpartum urinary retention after vaginal delivery. Int J Gynecol Obstet. 2011;112(2):112-5.
Gogarten W, Aken HV. A century of regional analgesia in obstetrics. Anesth Analg. 2000;91(4):773-5.
Gupta S, Partani S. Neuraxial techniques of labour analgesia. Indian J Anaesth. 2018;62(9):658.
Practice Guidelines for Obstetric Anesthesia. An updated report by the American Society of anesthesiologists task force on obstetric anesthesia and the society for obstetric anesthesia and perinatology. Anesthesiol J Am Soc Anesthesiol. 2016;124(2):270-300.
Practice Bulletin No. 177: obstetric analgesia and anesthesia. Obstet Gynecol. 2017;129(4):e73.
Royal College of Anaesthetists. Raising the Standard: a Compendium of Audit Recipes. 3rd Edition 2012. London: RCoA, 2012.
CSQ-ARB2012-SEC8.pdf, 2012. Available at: https://www.salg.ac.uk/system/files/CSQ-ARB2012-SEC8.pdf.
Koteles J, de Vrijer B, Penava D, Xie B. Maternal characteristics and satisfaction associated with intrapartum epidural analgesia use in Canadian women. Int J Obstet Anesth. 2012;21(4):317-23.
Tan DJA, Sultana R, Han NLR, Sia ATH, Sng BL. Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study. BMC Anesthesiol. 2018;18(1):50.
Female foeticide in India. UNICEF. Available at: http://www.unicef.in/PressReleases/227/Female-foeticide-in-India.
Frauenfelder S, Rijn R van, Radder CM, Vries MC de, Dijksman LM, Godfried MB. Patient satisfaction between remifentanil patient-controlled analgesia and epidural analgesia for labor pain. Acta Obstet Gynecol Scand. 2015;94(9):1014-21.
Morgan PJ, Halpern S, Lam-McCulloch J. Comparison of maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section. Can J Anesth. 2000;47(10):956.
Sindhvananda W, Leelanukrom R, Rodanant O, Sriprajittichai P. Maternal satisfaction to epidural and spinal anesthesia for cesarean section. J Med Assoc Thailand. 2004;87(6):628-35.
Nikkola E, Läärä A, Hinkka S, Ekblad U, Kero P, Salonen M. Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction. Acta Obstet Gynecol Scand. 2006;85(2):188-94.