Popularizing Labor Analgesia in China

Abstract

M any factors are used to identify women at risk for a cesarean delivery (CS). One factor that has not been analyzed is the ability of obstetric nurses to predict which women will subsequently deliver vaginally or abdominally. A PubMed search found no related articles and the authors undertook this prospective, blinded study to determine if a labor/delivery nurse can identify which parturients they are caring for will undergo a CS.Women Z18 years of age, with singleton gestations at Z37 weeks, were eligible for the study. Women planning a scheduled cesarean section and/or with breech presentations were excluded. Nurses directly involved with the care of each woman made a written prediction of mode of delivery, blinded to the parturient and other care personnel. Predictions were based on maternal age, race, gravidity, parity, body mass index, largest prior delivery if parous, estimated fetal weight, maternal pelvis, and labor progression, all recorded within 1 hour of admission for labor. Participating nurses all had an associate, bachelor, or Master of Science degree. A secondary analysis was used to determine the influence of nurse experience on the likelihood of a correct prediction.Of 2816 candidates, 199 parturients took part in the study; 34 nurses made predictions. The mean maternal age was 25.4 ± 5.2 years, with the majority being white (55%). The mean gestational age was 39.0 ± 1.5 weeks; mean birth weight was 3398 ± 500 g. The mean number of years the nurses had worked in labor and delivery was 8.9 ± 7.1 years; and the majority (92%) had a Bachelor of Science in Nursing degree. Overall, the nurses correctly predicted the route of delivery in 77% of the cohorts (154/199; 95% confidence interval, 71-82). Following an analysis of the sensitivity, specificity, and positive and negative predictive values, the pretest probability of a CS in this study was 29%; the probability of a correct prediction by nursing staff was only 51%. Years of nursing experience did not influence predictive accuracy.The study has some limitations, including the uneven mix of participating nurses' experience, but the authors concluded that overall predictive accuracy for the mode of delivery by nurses directly involved with laboring women was no better than 50/50. They suggested that this study be repeated among midwives and, if the predictive accuracy is high, it could provide another tool for improving risk perception and subsequent assignment to either a low-risk or high-risk intrapartum unit.

Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China

“…Nonmedically indicated cesarean deliveries result in excess maternal morbidity and mortality [11], as well as increased costs of medical care [12]. A factor possibly contributing to the high rate of cesarean delivery in China is the lack of readily available labor analgesia: less than 1% of laboring women in China currently receive some type of labor analgesia [13].…”

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

“…At present, the high CD rate is a social problem in China. However, there are few hospitals conventionally carrying out NA during delivery and labor to meet the needs of parturient women [12]. Many Chinese people think labor pain is normal which is difficult to be avoided for parturient women especially nulliparous, so some of them choose CD, especially MRCD.…”

The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective studyThe initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

“…At present, the high CD rate is a social problem in China. However, there are few hospitals conventionally carrying out NA during delivery and labor to meet the needs of parturient women [12] .…”