Women’s prelabour preference for epidural analgesia: a cross-sectional study among women from the Netherlands and Belgium

Abstract

Background: This study describes variables related to women’s prelabour preference for epidural analgesia (PEA) in two neighbouring countries with a comparable socio-economic and cultural background.

Methods: Dutch women in midwifery (n = 164) or obstetrical care (n = 162), and Belgian women (n = 188) of ≥36 weeks gestation with a singleton in cephalic presentation completed questionnaires on demographic factors, received labour analgesia information, perceived attitude of the caregiver towards epidural analgesia (EA), pain catastrophising and coping with labour pain. Multiple logistic regression analysis was performed with PEA as dependent variable.

Results: PEA was 9.9% in Dutch midwifery care, 25.5% in Dutch obstetrical care and 38.3% in Belgian care (p value < 0.001). In the Netherlands, maternal age of 35 years or older (OR 4.95; 95% confidence interval (CI) 2.03–12.08), positive attitude of the caregiver towards EA (OR 5.83; 95% CI 2.57–13.23) and a lower degree of coping (OR 3.61; 95% CI 2.24–5.82) were independently associated with PEA. In Belgium, only a lower degree of coping was associated with PEA (OR 4.06; 95% CI 2.45–6.73).

Conclusions: In both countries, women with a lower degree of coping had a higher PEA. Care setting in the Netherlands was not an independent variable.

• Coping
• fear of childbirth
• midwifery
• obstetrics
• pain

Acknowledgements

The authors thank all the midwives from the midwifery care centres who participated in this study. We are grateful to the following midwifery care centres in the Netherlands: midwifery care centre Meerssen, Meerssen; midwifery care centre Schoffelen-van Vleuten, Maastricht; midwifery care centre ‘t Bolleke, Hoensbroek; midwifery care centre Valkenburg, Valkenburg; and midwifery care centre Midden-Brabant, Boxtel. The authors also thank Prof. Raymond de Vries for critically reading the manuscript and Björn Winkens for advice in performing the statistical analyses.

Current knowledge on this subject

• No studies have been published on the influence of contributing factors to women’s prelabour PEA in the Netherlands with low-epidural use and in Belgium with a high rate of epidural analgesia.

• Pain cognitions and pain catastrophising in relation to a request for pain relief and epidural analgesia were examined in two earlier published studies [15,19].

What this study adds

• In the Netherlands, age of 35 or older, a positive attitude of the caregiver towards epidural analgesia and lower degree of labour pain coping were significantly independently associated with women’s prelabour PEA.

• In Belgium, only labour pain coping was a significant contributor to prelabour epidural analgesia preference.