Abstract
The painless delivery, recently included among the essential levels of care, is an application of epidural analgesia to the last stage of labor which may greatly improve the quality of childbirth experience. This technique is poorly used in Italy, because of the lack of information in the population, disruption of services and scarcity of economic resources. There are not many retrospective studies quantifying the use of this technique in recent years, nor clinical indicators highlighting any adverse event from the neonatal point of view. We describe the ten-year experience of a birth point belonging to a peripheral hospital, comparing two populations of neonates born in the same center in two different periods, in order to determine whether the routine use of analgesia in labor can influence the short-term neonatal outcome. We examined the basic data regarding all neonates born in the years 2004 and 2014. In 2004 the painless delivery was not yet used in our center, while in 2014 it was used routinely in every spontaneous birth. We examined data obtained retrospectively from the paper files of the delivery room and neonatal ones. The two populations of infants examined were comparable for baseline characteristics, such as full-term pregnancy, absence of obstetric risk factors and similar operative protocols for emergency caesarean section indications. For every baby the type of delivery, the Apgar score, the transfer rate in the neonatal intensive care unit and eventual death were marked. The analyzed data confirm that there are no statistically significant differences in short-term neonatal outcome between the two groups of infants.
Highlights
Epidural analgesia is a painless therapy used in Italy since more than sixty years, with good and proved efficacy, and its application to obstetrics allows labor in analgesia
A retrospective casecontrol study was published by Sylvanus Kampo in 2016, that evaluated the relationship between epidural analgesia, labor length, and perinatal outcomes
The conclusion was that complications in the epidural group were not statistically different from those in the control group and that epidural labor analgesia is safe for the fetus used to give the woman a larger and neonate
Summary
Epidural analgesia is a painless therapy used in Italy since more than sixty years, with good and proved efficacy, and its application to obstetrics allows labor in analgesia. The most effective technique for analgesia during labor and delivery is achieved by loco regional anesthesia and with central blocks performed at the lumbosacral level. In some Italian hospitals has been introduced the technique of analgesia during labor and vaginal delivery, first as an experiment, as routine. We do not have reliable data on its actual use, because often in the information flows is not recorded the use of analgesic techniques in the course of labor. This technique, widely used in Europe, is little used in Italy: according to official documents, only 10% of the Italians benefit from this practice, compared to 70% in France and Britain. Pregnant women interested in painless delivery, are appropriately educated in the months before birth through a preparation course inserted in the birth path, followed by anesthesia counseling
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