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OBSTETRIC ANESTHESIA

Predictors of Recommendation and Acceptance of Intrapartum Epidural Analgesia

Eyal Sheiner, MD^*,, Einat K. Sheiner, MD, Ilana Shoham-Vardi, PhD^,, Gabriel M. Gurman, MD^,§, Fernanda Press, MD^*,, Moshe Mazor, MD^*,, and Miriam Katz, MD^*,

*Department of Obstetrics and Gynecology, Faculty of Health Sciences, Epidemiology and Health Services Evaluation Department, and §Division of Anesthesiology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel

Address correspondence and reprint requests to Eyal Sheiner, MD, Department of Obstetrics and Gynecology, Soroka Medical Center, PO Box 151, Beer-Sheva 84101, Israel.

We conducted this prospective study to characterize the obstetric and sociodemographic variables that predict physicians’ recommendations and patients’ acceptance of intrapartum epidural analgesia. The study population consisted of 447 consecutive, low-risk parturients in early active labor. Epidural analgesia was recommended to 393 patients (87.9%), however only 164 (41.7%) consented to receive it. A multiple logistic regression analysis demonstrated that the severity of pain, as assessed by the medical staff (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0.57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients’ being secular compared with religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent predictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between parturients who accept and those who do not accept this analgesia. Implications: We studied the factors that influence the recommendation of epidural analgesia by obstetricians, as well as its acceptance by the laboring patients at a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who perceived greater pain were more secular, had low parity, and had a higher level of education were more likely to accept it.

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