Identification of maternal characteristics associated with the use of epidural analgesia

Havelhoehe Research Institute, Kladower Damm, Berlin.
Journal of Obstetrics and Gynaecology (Impact Factor: 0.55). 05/2012; 32(4):342-6. DOI: 10.3109/01443615.2012.661491
Source: PubMed


The present survey aims to identify predictors associated with the use of epidural analgesia (EA). Therefore, from October 2007 to June 2008, a survey was conducted in 193 pregnant women (mean age 31.7 years (SD 4.9); 64.8% primipara) attending a German general hospital with a specialisation in integrative medicine. Questionnaires, including Antonovsky's sense of coherence (SOC) were delivered antepartum. Delivery data were recorded within the hospital quality management programme. The adjusted odds ratio (OR) for EA use was significantly greater than one for women who had previously used EA (adjusted OR =4.1; CI: 1.03-16.31) and for the desire for a delivery without pain (adjusted OR =3.05; CI: 1.36-6.83). The likelihood of EA use decreased in multipara (adjusted OR =0.05; CI: 0.01-0.22). SOC was not found to be an independent predictor for EA use. However, women with high SOC more often preferred a delivery without EA (p for trend =0.037). In conclusion, first time labour, the desire for a delivery without pain and previous use of EA are independent predictors for the use of EA in labour. Further studies should clarify the predictive role of SOC in pregnancy.

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    • "Unlike Borrmann et al. (2002) this study found a pregnant woman's SOC was unrelated to planned place of birth with women with higher SOC scores being no more likely to plan a birth in a primary setting than women with lower SOC scores. Unlike other studies this study did not find that SOC was related to gestation (Sjostrom et al., 2004), parity (Sjostrom et al., 2004) or a desire to avoid epidural anaesthesia in labour (Jeschke et al., 2012). "
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    ABSTRACT: as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman׳s SOC and the childbirth choices she makes in pregnancy. the study aims to investigate the relationship between SOC and women׳s pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women׳s pregnancy choices. this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women׳s birthing outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 07/2015; 31(11). DOI:10.1016/j.midw.2015.07.012 · 1.57 Impact Factor
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    • "The higher the scores the more the sense of coherence. The SOC scale has been used in various contexts associated to pregnancy and childbirth (Jeschke et al., 2012; Tham et al., 2007; Sjoström et al., 2004).The tool has demonstrated validity and internal consistency (α ¼ 40.80) (Sjoström et al., 2004) and for the present sample the Cronbach's alpha coefficient was (α ¼0.85). "
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    ABSTRACT: this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors. a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records. data were recruited from antenatal health-care clinics in Halland, Sweden. a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42. five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States. results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy. this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 06/2015; 31(10). DOI:10.1016/j.midw.2015.05.005 · 1.57 Impact Factor
    • "There is considerable recent empirical evidence on factors associated with some of the individual elements of normal birth: determinants of type of onset of labour (Humphrey and Tucker, 2009), mode of birth (Coonrod et al., 2008), use of epidural analgesia (Jeschke et al., 2012), and use of episiotomy (Robinson et al., 2000; Allen and Hanson, 2005; Ogunyemi et al., 2006; Gossett and Dunsmoor-Su, 2008). Altogether, these studies provide consistent evidence that the determinants of various individual elements of normal birth are multifactorial and include parity, insurance status, care provider characteristics (e.g., discipline, experience), hospital characteristics (e.g., percentage of publicly-funded births, availability of in-house medical specialists), and the presence of maternal medical conditions such as diabetes and pre-eclampsia (Robinson et al., 2000; Allen and Hanson, 2005; Ogunyemi et al., 2006; Coonrod et al., 2008; Gossett and Dunsmoor-Su, 2008; Humphrey and Tucker, 2009; Jeschke et al., 2012). There is less consistent evidence for maternal age as a determinant of individual elements of normal birth, no evidence for the influence of some suggested care practices (i.e., ensuring mobility) and no research examining determinants of normal birth as a multidimensional construct that can be aligned with population targets for increasing 'normal birth' when evaluating policy initiatives. "
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    ABSTRACT: Background: currently, care providers and policy-makers internationally are working to promote normal birth. In Australia, such initiatives are being implemented without any evidence of the prevalence or determinants of normal birth as a multidimensional construct. This study aimed to better understand the determinants of normal birth (defined as without induction of labour, epidural/spinal/general anaesthesia, forceps/vacuum, caesarean birth, or episiotomy) using secondary analyses of data from a population survey of women in Queensland, Australia. Methods: women who birthed in Queensland during a two-week period in 2009 were mailed a survey approximately three months after birth. Women (n=772) provided retrospective data on their pregnancy, labour and birth preferences and experiences, socio-demographic characteristics, and reproductive history. A series of logistic regressions were conducted to determine factors associated with having labour, having a vaginal birth, and having a normal birth. Findings: overall, 81.9% of women had labour, 66.4% had a vaginal birth, and 29.6% had a normal birth. After adjusting for other significant factors, women had significantly higher odds of having labour if they birthed in a public hospital and had a pre-existing preference for a vaginal birth. Of women who had labour, 80.8% had a vaginal birth. Women who had labour had significantly higher odds of having a vaginal birth if they attended antenatal classes, did not have continuous fetal monitoring, felt able to 'take their time' in labour, and had a pre-existing preference for a vaginal birth. Of women who had a vaginal birth, 44.7% had a normal birth. Women who had a vaginal birth had significantly higher odds of having a normal birth if they birthed in a public hospital, birthed outside regular business hours, had mobility in labour, did not have continuous fetal monitoring, and were non-supine during birth. Conclusions: these findings provide a strong foundation on which to base resources aimed at increasing informed decision-making for maternity care consumers, providers, and policy-makers alike. Research to evaluate the impact of modifying key clinical practices (e.g., supporting women׳s mobility during labour, facilitating non-supine positioning during birth) on the likelihood of a normal birth is an important next step.
    Midwifery 04/2015; 31(8). DOI:10.1016/j.midw.2015.04.005 · 1.57 Impact Factor
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