An audit of the labour epidural analgesia service at a regional hospital in Gauteng Province, South Africa

Abstract

Background. Neuraxial analgesia in the form of a labour epidural has been shown to be the most effective analgesic strategy for the labouring mother. In developed countries, data are readily available as to the number of women receiving labour epidural analgesia, as well as the complication rates of labour epidurals. However, data for South Africa (SA) on labour epidural analgesia services are limited, and there were no published data for Rahima Moosa Mother and Child Hospital (RMMCH), Johannesburg, SA. Objective. To describe the labour epidural analgesia service at RMMCH over the period of 1 year. Methods. A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 January to 31 December 2014. Results. During the study period, labour epidural analgesia was administered for 187 (1.6%) of 11 853 deliveries. Epidural records were collected for all administered labour epidurals. The most common indications documented were labour analgesia (41.7%) and primigravida (28.9%). Labour epidurals were not administered for specific medical conditions. The incidence of complications was 22.6%, and these were minor and self-limiting. Hypotension was the most common complication (12.3%). Patient satisfaction with labour epidural analgesia, where documented, was high (98.4%). Conclusion. This audit revealed a low incidence of labour epidural analgesia at RMMCH during the study period. The incidence of complications was in keeping with that seen in developed countries. Poor documentation was noted to be a problem.

Factors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, NigeriaFactors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, Nigeria

“…The findings from this study showed that the demand for labor epidural analgesia was very low (2.6%) which was comparable with the results from other African settings. This agrees with previous South African independent reports of level of labor epidural utilization of 1.6% and 2.2% respectively [10,11]. It is also lower than 7.5% reported by Ezeonu in Abakiliki Nigeria and 10.6% reported by Olaleye et al in Ilesha, Nigeria [5].…”

“…Our study further noted that educated women dominated the demand for epidural analgesia because they are better informed about the trending events especially as it concerns their reproductive health. This submission therefore suggests that their knowledge of epidural technique for labor pains could have contributed to the level of demand observed which corroborated the reports of other authors [10][11][12][13].Additionally, parturients who utilized labour epidurals were significantly older than 30 years of age (p=0.002), multiparous (p=0.001), and were higher income earners (p=<0.001) This was in consistent with previous Vietnam Study [1]. .Apart from the knowledge of labor epidural analgesia, a few other concerns had continued to challenge its wide use in our setting which included the effect of epidural analgesia on the outcome of labor in terms of progress of labor, mode of delivery and backache.…”

“…We observed one case (2.8%) post-dural puncture headache but resolved spontaneously within 24 hours without any residual symptoms. This finding was similar to those reported from South Africa [10] and in high income countries [11,12]. This suggests that epidural analgesia can effectively and safely be deployed for women in labor [21][22][23][24].…”

Labour epidurals in Gauteng Province, South Africa

“…[19][20] This may be a result of similar limitations in service delivery in most public maternity hospitals, but further research is needed to determine this. The epidural rates were higher in public hospitals in 2015 than those reported in a study conducted by Leonard et al [21] This is most likely a result of the initiation of a 24/7 labour epidural service in 2015 at the same GP academic hospital initially evaluated by Leonard et al [21] in 2014.…”

“…Data available from two isolated public hospital audits suggest that the epidural frequency in public hospitals is <10%, and may be as low as 2.5%. [19][20][21] The highest number of births (n=296 621) were registered in Gauteng Province (GP) in 2015, [22] and represented 27% of the registered births in SA at the time. [22] Given the high number of births in the province and the lack of information on the provision of labour epidurals, to our knowledge, we conducted the first multisite survey of labour epidural provision in the private and public sector hospitals in GP.…”