Dickinson Jan E, Paech Michael J, McDonald Susan J, Evans Sharon F
School of Women's and Infants' Health, The University of Western Australia, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2003 Dec;43(6):463-8. doi: 10.1046/j.0004-8666.2003.00152.x.
To assess maternal satisfaction with childbirth and intrapartum pain relief in nulliparous women labouring at term.
Prospective randomised clinical trial comparing epidural and non-epidural analgesic techniques on term labour outcomes in nulliparous women. Within 24 h of delivery the women were surveyed regarding their opinions about the birthing experience and the allocated analgesic regimen. A postal survey was conducted 6 months postpartum to assess opinions about intrapartum analgesia in a subsequent pregnancy.
A total of 992 women were randomised to receive continuous midwifery support (CMS) or epidural (EPI) analgesia on presentation for delivery. There was a high crossover rate from CMS to EPI (61.2%) and a lesser non-compliance rate in the EPI group (27.8%). The early post-partum recollections revealed a high satisfaction with epidural analgesia and lower satisfaction with alternative pain relief measures. Ten percent of women in the CMS group reported negative feelings about their allocated pain relief compared with 1% in the EPI group (P < 0.001), and 10% of all women reported negative feelings about their overall childbirth experience. At the 6-month postpartum survey factors associated with the planned use of epidural analgesia in a subsequent pregnancy were induction of labour (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2, 4.7) and prior utilisation of epidural analgesia (OR 28.1, 95% CI 14.5, 54.7).
Maternal satisfaction with intrapartum analgesia was significantly higher with epidural analgesia than non-epidural analgesic techniques. Overall satisfaction scores for labour and delivery were high regardless of analgesic approach, reflecting the multiple issues other than pain relief that are involved in the childbirth experience.
评估足月分娩的初产妇对分娩及产时镇痛的满意度。
前瞻性随机临床试验，比较硬膜外和非硬膜外镇痛技术对初产妇足月分娩结局的影响。在分娩后24小时内，对产妇进行调查，询问她们对分娩经历和所分配镇痛方案的看法。产后6个月进行邮寄调查，以评估对后续妊娠产时镇痛的看法。
共有992名妇女在临产后被随机分配接受持续助产支持（CMS）或硬膜外（EPI）镇痛。从CMS组交叉至EPI组的比例较高（61.2%），EPI组的不依从率较低（27.8%）。产后早期回忆显示，产妇对硬膜外镇痛的满意度较高，对其他镇痛措施的满意度较低。CMS组10%的妇女对所分配的镇痛措施有负面感受，而EPI组为1%（P<0.001），10%的所有妇女对其总体分娩经历有负面感受。在产后6个月的调查中，与后续妊娠计划使用硬膜外镇痛相关的因素是引产（比值比（OR）2.4，95%置信区间（CI）1.2，4.7）和先前使用过硬膜外镇痛（OR 28.1，95%CI 14.5，54.7）。
与非硬膜外镇痛技术相比，硬膜外镇痛使产妇对产时镇痛的满意度显著更高。无论采用何种镇痛方法，分娩和接生的总体满意度得分都很高，这反映了分娩经历中除疼痛缓解之外的多个问题。
