Abstract
PurposePatient preferences for labor epidural analgesia (LEA) have been incompletely evaluated. This study aimed to determine the importance of various LEA outcomes to both antenatal and postpartum patients.MethodsThis was a cross-sectional study approved by the institutional ethics board. Questionnaires were distributed to two separate and distinct cohorts screened for eligibility: pregnant patients at an antenatal visit and postpartum patients during childbirth admission. A list of common LEA outcomes was compiled using research published in leading anesthesia journals. Participants ranked the outcomes according to perceived importance. They assigned each a number from 1 to 10 (priority ranking; 1 indicated the highest priority outcome and 10 the least). They were also asked to ‘spend’ $100 towards the outcomes (relative value scale), allocating more money to outcomes more important to them.ResultsTwo hundred twenty questionnaires were completed (105 antenatal, 115 postpartum). ‘Achieving desired pain relief’ was the most important outcome for both cohorts. It was valued more by the postpartum cohort (Median $50 (25 - 60) vs $30 (18 - 50)). ‘Overall satisfaction with the pain management,’ ‘experiencing a short time to achieve pain relief,’ and ‘experiencing a short duration of labor’ received more money than avoiding various LEA-related side effects. The postpartum cohort ranked ‘experiencing a short time to achieve pain relief’ as more important than the antenatal cohort (Median 5 (3 - 7) vs 3 (2 - 5)).ConclusionsAchieving the desired pain relief was the highest LEA outcome preference for both antenatal and postpartum patients. Avoiding side effects was less important relative to pain-related outcomes.
Highlights
IntroductionLabor analgesia is an important part of the childbirth experience
For many patients, labor analgesia is an important part of the childbirth experience
A list of common labor epidural analgesia (LEA) outcomes was compiled using research published in leading anesthesia journals
Summary
Labor analgesia is an important part of the childbirth experience. While there are several modalities to choose from, labor epidural analgesia (LEA) is most often considered the gold standard [1] and is currently utilized by the majority of laboring patients in the United States and Canada [2]. The majority of studies investigated factors associated with choosing LEA (e.g. previous epidural, fear of childbirth) [3,4,5] and overall satisfaction with the procedure [6]. Involving patients in clinical and research partnerships ensures their ability to influence decisions based on their priorities and builds a culture of engagement, this is currently under-utilized in obstetric anesthesia care [8]. Informing healthcare providers of patient preferences may help them to better understand their patients’ desires and guide the care they provide to meet the patients’ expectations
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