A Survey of Antenatal and Peripartum Provision of Information on Analgesia and Anaesthesia

Brinkler R, Edwards Z, Abid S, Oliver CM, Lo Q, Stewart A

Anaesthesia: 2019, 74, 1101-1111

Aim of Study

To investigate the quality of information given to pregnant women about options for analgesia in labour and anaesthesia for Caesarean section

Design and Location

Survey study, Greater London

Methodology

Online survey of women on postnatal wards of 28 Greater London hospitals

Primary Outcome

• Inter-relationship between the provision of information and:
  • Confidence in labour analgesia
  • Decisions and satisfaction with analgesia

Results

• Information received from:
  1. Midwives
  2. Antenatal classes (usually midwife led)
  3. Epidurals and Entonox®
• More women reported confidence if their best source of information was a private antenatal class or their midwife (OR 2.54)
• Those receiving information from midwives about epidurals were less likely to report confidence in their decisions
• Regarding CS:
  • 1% recalled receiving complete information
  • 2% did not recall receiving any information
• 8% investigated anaesthesia for CS using the internet
• Of 317 women who underwent CS:
  • 6% received complete information just before
  • 1% did not recall receiving any information
• Of 742 women planning a vaginal birth, regarding analgesia
  • 9% recalled receiving complete information
  • 17% did not recall receiving any information
• 7% investigated analgesia options using the internet
• Of 415 women who had an epidural:
  • 7% received complete information
  • 5% did not receive any information
• Epidurals were associated with increased satisfaction with analgesia
• Those receiving information about epidural analgesia for the first time during labour were less likely to indicate confidence
• 7% felt they were well enough informed to be confident about their analgesic choices
• 8% felt they were not given enough information or did not understand it
• Women who reported feeling confident to choose labour analgesia were more likely to report satisfaction (OR 2.67)
• Confidence to make decisions regarding labour analgesia was associated with having received verbal information on all analgesic modalities antenatally (OR 2.88)
• Antenatal referral to a doctor (anaesthetic or obstetric) was not associated with improvement in information provision

Conclusions/Discussions

• Women who were well informed in the antenatal period were more likely to report satisfaction
  • Collaboration with antenatal service providers could improve quality and retention of information
• Verbal information was best
  • Why is antenatal referral to anaesthetics not associated with improved information recall
• Midwives play a very important role
  • Women most confident with choices when midwife provides best information
  • Giving information regarding epidural analgesia results in less confidence

Stated Limitations from the Study

• Non-English speakers excluded
  • CMACE/CEMACH raise concerns that non-English speakers are morely likely to be poorly informed
• Relied on women remembering the information they had been given
  • Recall bias
• Only women admitted to postnatal ward surveyed

Discussion from Journal Club Meeting (?Change of Practice)

Midwives often encourage as little involvement of doctors as possible believing it is a natural process.

Epidurals and Caesarean sections not talked about in antenatal classes.

Anaesthetists from this hospital have previously been involved in antenatal classes but this has not continued.

Summary by Dr S Wong. Journal Club meeting 29 August 2019.

Images from http://www.labourpains.com