Anesthesia practices for management of labor pain and cesarean delivery in France (EPIDOL): A cross-sectional survey

Abstract

BackgroundThis study aimed to collect obstetric anesthesia practice and patient-reported outcomes as an update to the last French Obstetric Anesthesia survey from 1996. MethodsMaternity units were randomly selected across France and surveyed for 7 consecutive days from February, 2016, to January, 2017. Data was gathered prospectively by questionnaires filled out by patients and anesthesia providers. ResultsThere were 1885 questionnaires received from 56 units, with 379 cesarean delivery (CD) and 1506 vaginal delivery (VD) cases analyzed. The overall neuraxial labor analgesia (NLA) rate was 82.5% (95% CI [82.4–82.6]), with 70.3% (95% CI [71.4–71.6]) receiving automated administration (PCEA/PIEB). NLA was effective throughout labor in 68.2% of cases, however, severe pain was reported by 29.4% of patients. The overall rate of alternative approaches for labor analgesia was 19.5% (95%CI [19.2–19.7]). Obesity (OR 2.8; 95% CI [1.0−7.5], p < 0.04) and delivery in level I units (OR 0.6; 95% CI [0.5−0.9], p < 0.01) were associated with severe pain during VD. Satisfaction was found to be similar in patients delivering with or without NLA. The incidence of pain during CD was similar in scheduled versus non-scheduled CD. Failure of NLA during CD was associated with severe pain (OR 10.0; 95% CI [3.1−31.9], p < 0.01) and dissatisfaction (OR 26.2; 95% CI [3.0–225.1], p < 0.01). ConclusionDespite the high NLA rate in France, a significant proportion of women experience severe pain during labor and delivery. This study emphasizes the need for further practice guidelines in obstetric anesthesia to ensure optimal pain management and improve patients' experience during childbirth.clinicaltrials.govNCT02853890.