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

Zhao, Yun; Gao, Ying; Sun, Guoqiang; Yu, Ling; Lin, Yu-Cheng

doi:10.1186/s12884-020-03294-z

Cited by 3 publications

(4 citation statements)

References 27 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These responses, however, precludes any outside pressure from hospital administrators, who may also influence their service decision-making. The hospital administration’s unwillingness is an underestimated issue nationwide, although this may be skewed because most of the survey respondents work in the hospitals where LEA services are available [ 8 – 11 , 14 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is especially resounding because the salary of healthcare professionals in China is disproportionately low compared to other countries with more than 50% of compensation driven by case volume [23,28], similar to the US's fee-for-service system [24,25]. Studies indicate that increasing incentives to providers rapidly increases LEA and decreases CD rates with better maternal and infant outcomes and increased hospital revenue [8][9][10][11]29]. This might serve as a pathway for a short-term solution while more AN and OB personnel are trained.…”

Section: Plos Onementioning

confidence: 99%

“…Three large impact studies with approximately 50,000 parturients spearheaded by No Pain Labor & Delivery-Global Health Initiative (NPLD-GHI) since its inception in 2008 has confirmed that implementing 24/7 LEA services is correlated with lower rates of CD in 3 different settings (municipal maternal hospitals, academic institutions, and rural area hospitals) [8][9][10]. Anesthesiologists could play an important role in effectively decreasing the CD rate, given that LEA usage increased from < 1% to � 31% in some hospitals or regions from 2007 to 2018 [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers

et al. 2021

View full text Add to dashboard Cite

Objective China has a high cesarean delivery (CD) and low labor epidural analgesia (LEA) rate. This online survey was conducted to explore the reasons behind this phenomenon and potential solutions. Methods A voluntary, anonymous survey was distributed via both WeChat and professional websites for 4 months amongst groups of Chinese perinatal professionals. Data was collected and analyzed using a Chi-square test and presented as percentages of respondents. Results 1412 respondents were recorded (43% anesthesiologists, 35% obstetricians, 15.5% midwives or labor and delivery nurses, and 6.5% others), and 1320 respondents were care providers. It was found that 82.7% (1092/1320) of the provider respondents used CD per patient request in fear of lawsuits or yinao/yibao and 63.4% (837/1320) used CD for respecting superstitious culture. The number one reason (noted by 60.2% (795/1320) of all the three specialties) for low LEA use was lack of anesthesia manpower without statistical difference among specialties. The most recommended solution was increasing the anesthesia workforce, proposed by 79.8% (1053/1320) of the three specialties. However, the top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists. The later (83%, 504/606) suggested increasing the incentive to provide the service is more effective. The answers to questions related to medical knowledge about CD and LEA, and unwillingness of anesthesiologists, parturients and their family members to LEA were similar for the most part, while the opinions regarding low LEA use related to poor experiences and unwillingness of obstetricians and hospital administrators were significantly divided among the three specialties. In the providers’ point of view, the unwillingness to LEA from parturient’s family members was the most salient (26.1%, 345/1320), which is more than all care providers, hospital administrators, and parturients themselves (16.8%, 222/1320). Conclusion The reasons for high CD rate and low LEA use are multifactorial. The sociological issues (fear of yinao/yibao and superstitious culture) were the top two contributing factors for the high CD rate in China, while lack of anesthesia manpower was the top response for the low LEA use, which contributes to its being the most recommended solution overall from the three specialties. An incentive approach to providers is a short-term solution while training more perinatal care providers (especially among anesthesiologists and midwives), improving billing systems, and reforming legal systems are 3 systemic approaches to tackling this problem in the long-term.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers

et al. 2021

View full text Add to dashboard Cite

show abstract

“…We retrospectively assessed outcomes for both maternal and neonates, including labor progress, delivery mode, PPH, intrapartum fever, transfer to ICU, admission to NICU, meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min, in comparison to those who did not receive NA. The initial dose administered of NA through the programmed intermittent epidural bolus (PIEB) pump consisted of 10mL of a drug mixture containing 0.08% ropivacaine and 2 µg/mL fentanyl [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Cheng,

Xiong,

et al. 2024

BMC Anesthesiol

Self Cite

View full text Add to dashboard Cite

Background The mechanism underlying maternal fever and prolonged labor progression associated with neuraxial analgesia (NA) remains elusive, raising concerns among certain pregnant women regarding the application of NA during vaginal delivery. This study aimed to investigate the impact of early and late NA on maternal and neonatal outcomes in multiparous women. Methods This retrospective study collected data from 1119 multiparous women with singleton pregnancies, full term and live births at our labor and delivery center between August 1st, 2021 and July 31st, 2022. Based on the timing of NA initiation, participants were categorized into three groups: no-NA, early-NA and late-NA. The no-NA group comprised of 172 women who did not receive NA during vaginal delivery; the early-NA group included 603 women in which NA was initiated when cervical dilation was between 0.5 and 2.0 cm; and the late-NA group comprising 344 cases in which NA was initiated at the cervical dilation of ≥ 2 cm. Maternal and neonatal outcomes were observed, including durations of the first, second, third and total stage of labor, the rate of intrapartum cesarean delivery (CD), intrapartum fever, postpartum hemorrhage (PPH), transfer to intensive care unit (ICU), admission to the neonatal intensive care unit (NICU), meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min. Results No differences were noted in the maternal age, body mass index (BMI) on admission, gestations, parity, gestational weeks at delivery and neonatal birth weight, or the rate of gestational diabetes mellitus (GDM) and hypertension disorder did not significantly differ among the three groups (p > 0.05). The no-NA group had shorter durations of first stage, second stage of labor compared to the early-NA or late-NA group (median, 215.0 min and 10.0 min vs. 300.0 min and 12.0 min vs. 280.0 min and 13.0 min) (p < 0.05), but no differences were observed between the early-NA and late-NA group (p > 0.05). There were no differences in the rate of intrapartum CD, intrapartum fever, PPH, maternal transferred to ICU, neonatal transfer to NICU, meconium-stained amniotic fluid, and postpartum stay ≥ 7d, as well as the neonatal the Apgar scores at 1 and 5 min among the three groups (p > 0.05). Conclusion NA is associated with extended durations of the first, second and total stages of labor. However, the early initiation of NA in multiparous women (cervical dilation within 0.5-2.0 cm) does not increase the risk of intrapartum CD or intrapartum fever. These findings endorse the secure utilization of early NA for pain relief during labor in multiparous women.

show abstract

Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China

Li,

Yang,

Peng

et al. 2024

Ir J Med Sci

View full text Add to dashboard Cite

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

Cited by 3 publications

References 27 publications

Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers

Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China

Contact Info

Product

Resources

About