Abstract
Introduction: One of the health system concerns is the use of medications for pain relief during labor and its side effects. Therefore, the aim of this study was to investigate the effect of epiduralspinal anesthesia (combined anesthesia [CA]) on labor outcome and satisfaction in pregnant women. Methods: In this randomized controlled trial study, we included 80 nulliparous women who had been admitted to Fatemieh hospital (Hamadan, Iran) during 2015-2016 due to spontaneous onset of labor. They were randomly assigned into 2 groups of 40, one group with CA versus normal vaginal delivery (NVD) group. Data were collected by using of demographic questionnaire, satisfaction questionnaire, and baby truck scales. Data were analyzed by descriptive and analytical statistics in SPSS version 16.0. Results: Average maternal age (mean ± SD) in the CA group was 26.94 ± 4.34 and in the NVD group was 25.89 ±5.18, respectively. There was a significant difference between the 2 groups in terms of length of second stage of labor (P=0.001), headache (P=0.04), and Apgar score (first minute) (P=0.001). Chi-square test showed a significant difference between the 2 groups in terms of satisfaction with childbirth (P=0.004). Conclusion: In this study, labor pain relief by using the spinal-epidural anesthesia (CA) increased the labor satisfaction. Nevertheless, this approach was associated with some maternal and neonatal complications such as: headaches, length of third stage of labor, and low Apgar score. It seems that the use of this method for painless delivery requires further studies.
Highlights
One of the health system concerns is the use of medications for pain relief during labor and its side effects
Studies have shown that the fear of labor pain and less pain in cesarean section are the main reasons for the refusal of vaginal delivery in pregnant women
Kolmogorov-Smirnov test showed that our data followed a normal distribution for the length of active phase of labor (P = 0.08), the length of second phase (P = 0.45), the length of third stage of labor (P = 0.28), Apgar score (P = 0.35), Apgar score (P = 0.09), start time of breast-feeding after birth (P = 0.06), the volume of postpartum hemorrhage (P = 0.24), headache after delivery (P = 0.34), and the use of delivery appliances (P = 0.5)
Summary
One of the health system concerns is the use of medications for pain relief during labor and its side effects. Conclusion: In this study, labor pain relief by using the spinal-epidural anesthesia (CA) increased the labor satisfaction This approach was associated with some maternal and neonatal complications such as: headaches, length of third stage of labor, and low Apgar score. Among the factors that affect labor pain perception and response are the number and type of deliveries, fetal size, and position of the fetus in the womb.[2,3] Fear of labor pain leads to the increased secretion of catecholamines (stress hormones), subsequent reduction in the efficiency of uterine contractions, prolongation of the delivery process, reduction in blood supply to the uterus, and fetal hypoxia These in turn may lead to the increased incidence of obstetric interventions and the increase in the likelihood of the need for emergency cesarean.[4,5,6,7] Studies have shown that the fear of labor pain and less pain in cesarean section are the main reasons for the refusal of vaginal delivery in pregnant women. 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