Popularizing labor analgesia in China

Fan, Zi Tian; Gao, Xue; Yang, Huixia

doi:10.1016/j.ijgo.2007.03.007

Cited by 21 publications

(9 citation statements)

References 3 publications

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“…The standardized promotion of labour neuraxial analgesia among a large number of women in a single hospital had only been available in China since 2001 [31]. To slow the increase in CS rates and improve women's health, Chinese obstetric experts have proposed popularizing labour neuraxial analgesia among vaginal deliveries in China [32]. Several relevant actions have been taken [4,33].…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

“…The factors that influence the popularization of labour neuraxial analgesia are complex, such as education and parity [32,[34][35][36][37]. Reimbursement for neuraxial analgesia may increase hospital income and thus serve as an incentive, but could lead to the overuse of labour analgesia in some hospitals [2].…”

Section: Discussionmentioning

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

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“…The perceived pain during labour causes generalised neuroendocrinal stress response including increased oxygen consumption, hyperventilation, increased cardiac output, impaired uterine contractility, metabolic acidemia, and increased maternal-fetal mortality and morbidity [ 4 ]. So, many labor pain management strategies named painless childbirth methods have been developed and widely used in recent years [ 5 , 6 ]. Painless childbirth methods include pharmacologic (such as regional anesthesia, paracervical block, pudendal block, and systemic analgesia) and nonpharmacologic methods (such as psychoprophylactic method, hypnosis, and acupuncture).…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Fear of Childbirth and Women’s Knowledge about Painless Childbirth

Aksoy

Dostbil

et al. 2014

Obstetrics and Gynecology International

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This study investigated the association between fear of childbirth (FOC) and women's knowledge about painless childbirth methods. The study was performed on 900 multiparous women within the last month of pregnancy. Data was obtained through a questionnaire including the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) Turkish form A. FOC was defined as W-DEQ sum score ≥85. Women were questioned about their knowledge about painless childbirth and the most important source of this knowledge. Group 1 consists of participants with knowledge about painless childbirth. Group 2 consists of participants without knowledge about painless childbirth. Five hundred and twenty-four women (58.2%) had knowledge while 376 women (41.7%) had no knowledge about painless childbirth. Mean W-DEQ scores in group 1 (68.46 ± 12.53) were found to be lower than group 2 (71.35 ± 12.28) (P = 0.001). FOC was associated with increased maternal request for elective caesarean section (OR 4.22, 95% CI 2.91–6.11). Better informed pregnant women about painless childbirth methods may reduce the number of women with FOC and the rate of preferred elective caesarean section.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao

Gao

Sun

et al. 2020

BMC Pregnancy Childbirth

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Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = − 0.782 (95%CI [− 0.948, − 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = − 0.914 (95%CI [− 0.989, − 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). Conclusions Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

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Popularizing labor analgesia in China

Cited by 21 publications

References 3 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

The Relationship between Fear of Childbirth and Women’s Knowledge about Painless Childbirth

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

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