Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Int J Obstet Anesth. 2013 Apr;22(2):119-23. doi: 10.1016/j.ijoa.2012.11.003. Epub 2013 Feb 23.
The decision to use, or not use, neuraxial analgesia is complex and likely multi-factorial. The objectives of this study were to understand parturients' concerns about neuraxial analgesia, and the reasons for not anticipating the use of neuraxial analgesia using qualitative methodology.
English-speaking, term parturients, who had not requested or received labor analgesia, were recruited for this mixed-methods study. In addition to a quantitative survey, the results of which have been published elsewhere, women were asked open-ended questions regarding concerns about neuraxial analgesia and reasons for not anticipating its use. Answers were recorded verbatim and analyzed using qualitative methodology.
Interviews were conducted with 509 women. Thirty-nine percent of patients expressed some concern about neuraxial analgesia. These concerns were thematically represented by misunderstandings about neuraxial analgesia, general fears about the procedure, and lack of trust in providers. Many of the concerns were misunderstandings that were not supported by the medical literature. Of the 129 patients who did not anticipate using neuraxial analgesia, 23% stated that this was because they desired a natural childbirth and/or control over their labor experience, whereas 46% cited concerns about the procedure and its complications as the basis for their decision.
Many women who anticipate not using neuraxial analgesia may be basing their decision on an inaccurate understanding of the risks of the procedure. Improved patient education and counseling that target specific areas of concern may address these misunderstandings.
使用或不使用脊神经镇痛是一个复杂的决策，可能涉及多个因素。本研究的目的是使用定性方法了解产妇对脊神经镇痛的担忧，以及不预期使用脊神经镇痛的原因。
本混合方法研究招募了讲英语的足月产妇，这些产妇没有要求或接受过分娩镇痛。除了发表在其他地方的定量调查结果外，还向女性询问了有关脊神经镇痛担忧和不预期使用其原因的开放式问题。答案逐字记录，并使用定性方法进行分析。
对 509 名妇女进行了访谈。39%的患者对脊神经镇痛表示有些担忧。这些担忧通过对脊神经镇痛的误解、对程序的一般恐惧和对提供者的不信任来体现。许多担忧是没有医学文献支持的误解。在 129 名不预期使用脊神经镇痛的患者中，23%表示这是因为他们希望自然分娩和/或控制自己的分娩经历，而 46%则将对程序及其并发症的担忧作为他们决策的基础。
许多预期不使用脊神经镇痛的女性可能基于对该程序风险的不准确理解做出决定。改善针对特定关注点的患者教育和咨询可能会解决这些误解。
