No pain management for labour: individual and organisational determinants: A secondary analysis of the 2016 French National Perinatal Survey.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
entrez:
24
5
2022
pubmed:
25
5
2022
medline:
27
5
2022
Statut:
ppublish
Résumé
Disparities in access to pain management have been identified in several care settings, such as emergency departments and intensive care units, but with regard to labour analgesia, it remains poorly explored. To determine the proportion of women without pain management during labour and its individual and organisational determinants. Secondary analysis of a nationwide cross-sectional population-based study, the 2016 French National Perinatal Survey. All maternity units in France. Ten thousand and eleven women who attempted vaginal delivery with a labour duration at least 15 min. Absence of pain management, defined as absence of any pharmacological or nonpharmacological analgesic method during labour. Among the 10 011 women included, 542 (5.4%) had no labour pain management: 318 (3.7%) of the 8526 women who initially preferred to use neuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalised estimating equations stratified according to the maternal antenatal preference for neuraxial analgesia, the common determinants of no labour pain management in both groups were no attendance at childbirth education classes and admission to a delivery unit during the night. Among women who initially preferred to use neuraxial analgesia, those who delivered in units with <1500 annual deliveries compared with units with 2000 to 3499 annual deliveries, were more likely to do without pain management [adjusted odds ratio (OR) = 1.96; 95% confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to use it, women born abroad were more likely to do without labour pain management (adjusted OR = 1.64; 95% CI, 1.12 to 2.40). In France, 1 : 20 women had no labour pain management, and this proportion was three times higher among women who preferred not to use neuraxial analgesia. Enhancing maternal information on labour pain and its management, especially nonpharmacological methods, and rethinking care organisation, could improve access to analgesia of any kind.
Sections du résumé
BACKGROUND
Disparities in access to pain management have been identified in several care settings, such as emergency departments and intensive care units, but with regard to labour analgesia, it remains poorly explored.
OBJECTIVES
To determine the proportion of women without pain management during labour and its individual and organisational determinants.
DESIGN
Secondary analysis of a nationwide cross-sectional population-based study, the 2016 French National Perinatal Survey.
SETTINGS
All maternity units in France.
PARTICIPANTS
Ten thousand and eleven women who attempted vaginal delivery with a labour duration at least 15 min.
MAIN OUTCOME MEASURE
Absence of pain management, defined as absence of any pharmacological or nonpharmacological analgesic method during labour.
RESULTS
Among the 10 011 women included, 542 (5.4%) had no labour pain management: 318 (3.7%) of the 8526 women who initially preferred to use neuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalised estimating equations stratified according to the maternal antenatal preference for neuraxial analgesia, the common determinants of no labour pain management in both groups were no attendance at childbirth education classes and admission to a delivery unit during the night. Among women who initially preferred to use neuraxial analgesia, those who delivered in units with <1500 annual deliveries compared with units with 2000 to 3499 annual deliveries, were more likely to do without pain management [adjusted odds ratio (OR) = 1.96; 95% confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to use it, women born abroad were more likely to do without labour pain management (adjusted OR = 1.64; 95% CI, 1.12 to 2.40).
CONCLUSION
In France, 1 : 20 women had no labour pain management, and this proportion was three times higher among women who preferred not to use neuraxial analgesia. Enhancing maternal information on labour pain and its management, especially nonpharmacological methods, and rethinking care organisation, could improve access to analgesia of any kind.
Identifiants
pubmed: 35608876
doi: 10.1097/EJA.0000000000001682
pii: 00003643-202206000-00002
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
489-497Informations de copyright
Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
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