Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland.
BMJ Open. 2022 May 9;12(5):e061186. doi: 10.1136/bmjopen-2022-061186.
The aim of this study was to analyse the relation between the used labour pain relief and childbirth experience measured by Visual Analogue Scale (VAS).
A retrospective cohort study.
Childbirth in five Helsinki University Hospital delivery units from 2012 to 2018.
Childbirth experience measured by VAS and classified in three groups (negative VAS=1-5, positive VAS=6-8 and highly positive=9-10).
The use of epidural or non-epidural compared with non-medical pain relief methods decreased the likelihood to experience highly positive childbirth for primiparous (adjusted OR (aOR)=0.64, 95% CI 0.57 to 0.73; and aOR=0.76, 95% CI 0.66 to 0.87) and multiparous (aOR=0.90, 95% CI 0.84 to 0.97 and aOR=0.80, 95% CI 0.74 to 0.86) parturients. The effects of epidural differed between primiparas and multiparas. In multiparas epidural was associated with decreased odds for experiencing negative childbirth compared with the non-medical group (aOR=0.70, 95% CI 0.57 to 0.87), while the effect of epidural was considered insignificant in primiparas (aOR=1.28, 95% CI 0.93 to 1.77).
While the use of medical-epidural and non-epidural-pain relief methods were not associated with odds for experiencing negative childbirth in primiparas, using epidural helps to avoid negative experience in multiparas. However, the odds for experiencing highly positive childbirth were decreased if the parturients used any medical pain relief for both primiparas and multiparas. Consequently, the effect of pain relief on the childbirth experience is strongly confounded by indication. Thus, the use of pain relief per se plays a limited role in the complex formation of the overall childbirth experience.
本研究旨在分析使用的分娩镇痛方法与通过视觉模拟评分法（VAS）测量的分娩体验之间的关系。
回顾性队列研究。
2012 年至 2018 年，在赫尔辛基大学医院的五个分娩单位进行分娩。
通过 VAS 测量的分娩体验，并分为三组（VAS 评分为 1-5 为负面，VAS 评分为 6-8 为正面，VAS 评分为 9-10 为高度正面）。
与非医学镇痛方法相比，使用硬膜外或非硬膜外镇痛方法降低了初产妇高度正面分娩体验的可能性（调整后的比值比（aOR）=0.64，95%可信区间 0.57 至 0.73；aOR=0.76，95%可信区间 0.66 至 0.87）和经产妇（aOR=0.90，95%可信区间 0.84 至 0.97；aOR=0.80，95%可信区间 0.74 至 0.86）。硬膜外的作用在初产妇和经产妇之间有所不同。在经产妇中，与非医学组相比，硬膜外与负面分娩体验的可能性降低相关（aOR=0.70，95%可信区间 0.57 至 0.87），而在初产妇中，硬膜外的效果被认为不显著（aOR=1.28，95%可信区间 0.93 至 1.77）。
虽然在初产妇中，使用医学-硬膜外和非硬膜外镇痛方法与负面分娩体验的可能性无关，但使用硬膜外有助于避免经产妇的负面体验。然而，如果初产妇和经产妇都使用任何医学镇痛方法，那么体验高度正面分娩的可能性就会降低。因此，疼痛缓解对分娩体验的影响受到强烈的混杂因素的影响。因此，疼痛缓解本身在复杂的整体分娩体验形成中所起的作用有限。
