Factors associated with the use of non-pharmacological analgesia for labor pain management

Abstract

Abstract Background For a decade, pain labor management has evolved: if neuraxial analgesia remains the gold standard, non-pharmacological methods are developing. We aimed to identify individual and organizational factors associated with the use of non-pharmacological analgesia, combined or not with neuraxial analgesia. Methods Women who attempted vaginal delivery with labor analgesia were selected from the 13,147 participants of the 2016 National Perinatal Survey. Labor analgesia was studied as follows: neuraxial analgesia only (NA), non-pharmacological analgesia only (NPA) or neuraxial and non-pharmacological methods combined (NA+NPA). Associations between individual and organizational characteristics were studied using a multilevel multinomial logistic regression. Results Among the 9 231 women included, 62.4% had NA only, 6.5% had NPA only and 31.1% had NA+NPA. Both NPA and NA+NPA were associated with multiparity with antenatal classes, educational level ≥ 5 years post graduate, antenatal preference to deliver without NA, and delivery in public maternity units. The use of NPA only was positively associated with non-permanent availability of the anesthesiologist and with a high number of midwives per shift in maternity units. Contrastingly, NPA only was negatively associated with foreign nationality and oxytocin use for induction or augmentation of obstetrical labor. NA+NPA was positively associated with primiparity with antenatal classes, but negatively with inadequate prenatal care. Conclusions Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. NPA and NA+NPA were associated with individual characteristics as well as characteristics of management of labor and organization of maternity units. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system. Key messages Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system.