Patient and Provider Perceptions of Decision Making About Use of Epidural Analgesia During Childbirth: A Thematic Analysis

Goldberg, Holly Bianca; Shorten, Allison

doi:10.1891/1058-1243.23.3.142

Cited by 8 publications

(19 citation statements)

References 23 publications

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“…women from countries where epidural use is not the norm). Women felt reassured and relieved by knowing an epidural was available.8 studies: [18, 28–30, 33–36]Moderate Desires for pain relief 2. Pre-existing desires for pain relief: Women expressed a desire for epidural due to reasons such as wanting a pain-free labour, a fear of pain and a desire to remain in control during labour10 studies: [18, 27–35]Moderate Desires for pain relief 3.…”

Section: Resultsmentioning

confidence: 99%

Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

et al. 2019

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Background Many women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women’s views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women’s views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women’s decisions and choices and to inform guidelines, policy, and practice. Methods We searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women’s accounts of different pain relief methods . Results From 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural ( n = 12), opioids ( n = 3), relaxation ( n = 8) and massage ( n = 4) – all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. ‘ Desires for pain relief’ illuminates different reasons for using pharmacological or non-pharmacological pain relief. ‘Impact on pain’ describes varying levels of effectiveness of the methods used. ‘ Influence and experience of support’ highlights women’s positive or negative experiences of support from professionals and/or birth companions. ‘ Influence on focus and capabilities’ illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, ‘ impact on wellbeing and health’ reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes. Conclusion Women report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.

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Section: Resultsmentioning

confidence: 99%

Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

et al. 2019

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“…At times, the woman's authoritative knowledge may differ from the dominant medical discourses held by healthcare professionals. Indeed, studies indicate that women and the medical profession often have divergent views on the nature and process of childbirth and the context in which it is viewed [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Listening to women’s voices: the experience of giving birth with paramedic care in Queensland, Australia

Flanagan

Lord

Reed

et al. 2019

BMC Pregnancy Childbirth

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Background: Unplanned out-of-hospital birth is generally assumed to occur for women who are multiparous, have a history of a short pushing phase of labour or are experiencing a precipitate birth. However, there is little research that examines the woman's perspective regarding factors that influenced their decision on when to access care. This research aimed to explore women's experience of unplanned out-of-hospital birth in paramedic care. Due to the size of the data in the larger study of 'Women's experience of unplanned out-of-hospital birth in paramedic care' [1], this paper will deal directly with the women's narrative concerning her decision to access care and how previous birth experience and interactions with other healthcare professionals influenced her experience. Method: Narrative inquiry, underpinned from a feminist perspective, was used to guide the research. Twenty-two women who had experienced an unplanned out-of-hospital birth within the last 5 years in Queensland, Australia engaged in this research. Results: The decision of a woman in labour to attend hospital to birth her baby is influenced by information received from healthcare providers, fear of unnecessary medical intervention in birth, and previous birth experience. All themes and subthemes that emerged in the women's narratives relate to the notion of birth knowledge. These specifically include perceptions of what constitutes authoritative knowledge, who possesses the authoritative knowledge on which actions are based, and when and how women use their own embodied knowledge to assess the validity of healthcare workers' advice and the necessity for clinical intervention. Conclusions: The women interviewed communicated a tension between women's knowledge, beliefs and experience of the birth process, and the professional models of care traditionally associated with the hospital environment. It is essential that information provided to women antenatally is comprehensive and comprehensible. The decisions women make concerning their birth plan represent the women's expectations for their birth and this should be used as a means to openly communicate issues that may impact the birth experience.

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“…The finding that preference for use of epidural analgesia was not associated with change in knowledge scores was not unexpected, given prior work reporting the influence of external factors on preference, such as partner preference and previous experience with epidural analgesia, 7 as well as perceptions of caregivers' preferences. 17 In focus group discussions, women appeared more likely to voice their attitudes and experiences if they preferred to avoid an epidural (eg, to have an unmedicated delivery). This finding suggests that there may be social pressure to avoid pain relief medications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Information Pamphlet for Women Considering Epidural Analgesia in Labour

Munro

Hui

Gemmell

et al. 2018

Journal of Obstetrics and Gynaecology Canada

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Patient and Provider Perceptions of Decision Making About Use of Epidural Analgesia During Childbirth: A Thematic Analysis

Cited by 8 publications

References 23 publications

Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

Listening to women’s voices: the experience of giving birth with paramedic care in Queensland, Australia

Evaluation of an Information Pamphlet for Women Considering Epidural Analgesia in Labour

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