Attanasio Laura, Kozhimannil Katy B, Jou Judy, McPherson Marianne E, Camann William
From the Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota; National Institute for Children's Health Quality, Boston, Massachusetts; and Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2015 Oct;121(4):974-980. doi: 10.1213/ANE.0000000000000546.
Most women who give birth in United States hospitals receive neuraxial analgesia to manage pain during labor. In this analysis, we examined themes of the patient experience of neuraxial analgesia among a national sample of U.S. mothers.
Data are from the Listening to Mothers II survey, conducted among a national sample of women who delivered a singleton baby in a U.S. hospital in 2005 (N = 1,573). Our study population consisted of women who experienced labor, did not deliver by planned cesarean, and who reported neuraxial analgesia use (n = 914). We analyzed open-ended responses about the best and worst parts of women's birth experiences for themes related to neuraxial analgesia using qualitative content analysis.
Thirty-three percent of women (n = 300) mentioned neuraxial analgesia in their open-ended responses. We found that effective pain relief was frequently spontaneously mentioned as a key positive theme in women's experiences with neuraxial analgesia. However, some women perceived timing-related challenges with neuraxial analgesia, including waiting in pain for neuraxial analgesia, receiving neuraxial analgesia too late in labor, or feeling that the pain relief from neuraxial analgesia wore off too soon, as negative aspects. Other themes in women's experiences with neuraxial analgesia were information and consent, adverse effects of neuraxial analgesia, and plans and expectations.
The findings from this analysis underscored the fact that women appreciate the effective pain relief that neuraxial analgesia provides during childbirth. Although pain control was 1 important facet of women's experiences with neuraxial analgesia, their experiences were also influenced by other factors. Anesthesiologists can work with obstetric clinicians, nurses, childbirth educators, and pregnant and laboring patients to help mitigate some of the challenges with timing, communication, neuraxial analgesia administration, or expectations that may have contributed to negative aspects of women's birth experiences.
在美国医院分娩的大多数女性会接受椎管内镇痛以控制分娩期间的疼痛。在本分析中，我们在美国母亲的全国样本中研究了椎管内镇痛患者体验的主题。
数据来自“倾听母亲II”调查，该调查针对2005年在美国医院分娩单胎婴儿的全国女性样本进行（N = 1573）。我们的研究人群包括经历过分娩、未通过计划剖宫产分娩且报告使用过椎管内镇痛的女性（n = 914）。我们使用定性内容分析法分析了关于女性分娩经历中最佳和最差部分的开放式回答中与椎管内镇痛相关的主题。
33%的女性（n = 300）在开放式回答中提到了椎管内镇痛。我们发现，有效的疼痛缓解经常被自发地提及为女性椎管内镇痛体验中的一个关键积极主题。然而，一些女性认为椎管内镇痛存在与时间相关的挑战，包括在疼痛中等待椎管内镇痛、分娩过程中接受椎管内镇痛太晚，或者感觉椎管内镇痛带来的疼痛缓解消失得太快，这些都被视为消极方面。女性椎管内镇痛体验的其他主题包括信息与同意、椎管内镇痛的不良反应以及计划和期望。
该分析结果强调了这样一个事实，即女性赞赏椎管内镇痛在分娩期间提供的有效疼痛缓解。虽然疼痛控制是女性椎管内镇痛体验的一个重要方面，但她们的体验也受到其他因素的影响。麻醉医生可以与产科临床医生、护士、分娩教育工作者以及孕妇和产妇合作，以帮助减轻一些可能导致女性分娩经历消极方面的时间、沟通、椎管内镇痛给药或期望方面的挑战。
