Impact of the Introduction of Neuraxial Labor Analgesia on Mode of Delivery at an Urban Maternity Hospital in China

Hu, Ling; Zhang, J.; Wong, Cynthia A.; Cao, Qing; Zhang, G.; Rong, Hu; Li, X.; MacCarthy, R.J.

doi:10.1097/01.aoa.0000479527.42027.05

Cited by 4 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because randomized controlled trials (RCTs) are often limited in terms of generalizability [8], the evidence provided by real-world observational studies can complement the findings from RCTs [9]. Previous studies on the association between labour neuraxial analgesia and adverse maternal and perinatal outcomes in China are mostly limited in single hospital with small sample sizes [10,11].…”

Section: Introductionmentioning

confidence: 99%

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Wang

et al. 2021

BMC Med

View full text Add to dashboard Cite

Background There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. Methods We used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. Results Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. Conclusions The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

show abstract

Section: Introductionmentioning

confidence: 99%

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Wang

et al. 2021

BMC Med

View full text Add to dashboard Cite

show abstract

“…Furthermore, implementing epidural analgesia during labor can increase vaginal birth rates as this intervention reduces women’s fear of labor pain 4 and is safe for both the mother and newborn 29,30 . In addition, a study in China showed that offering analgesia during labor reduced rated of cesarean delivery 31 . This is particularly relevant because of the public health concern and debate over the worldwide increase in cesarean deliveries, which is reflected in the rates of cesarean delivery in this survey 32,33 …”

Section: Discussionmentioning

confidence: 87%

Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health

Souza

Cecatti

Guida

et al. 2020

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Objective To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. Methods A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross‐sectional, facility‐based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design‐based χ2 test. Results Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. Conclusion Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low‐HDI countries. Whether low use of analgesia reflects women’s desire or an unmet need for pain relief requires further studies.

show abstract

“…It could reduce the risk of postpartum psychological disorders of women [23]. However, labor analgesia was not widely used in China [24]. Especially in general hospitals, the shortage of anesthetists renders plenty of women unable to receive the service of analgesia during childbirth [25].…”

Section: Discussionmentioning

confidence: 99%

Women's experience of psychological birth trauma in China: a qualitative study

Zhang

Dai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers' health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women's lived experiences of psychological birth trauma during labor and birth.Methods: A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within one week after birth. Colaizzi's method was used to analyze the data.Results: Twenty-four women participated in the study. Four themes emerged to describe the women's experience of psychological birth trauma: "How am I supposed to relieve the endless pain?" " Can't I be weak?" "Am I not important?" " What uncertainties are waiting for me?"Conclusions: The findings provide deep insight into Chinese women's unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

show abstract

Impact of the Introduction of Neuraxial Labor Analgesia on Mode of Delivery at an Urban Maternity Hospital in China

Cited by 4 publications

References 0 publications

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health

Women's experience of psychological birth trauma in China: a qualitative study

Contact Info

Product

Resources

About