Pathways to violated expectations of epidural uptake

Abstract

Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum actual epidural uptake followed by maternal postpartum reporting. Background: Childbearing women may or may not expect to have an epidural in childbirth, but the match between expected and actual epidural uptake has not been examined. The issue is important because childbirth expectations have been associated with actual experiences and later adjustment. Methods: Prospective, longitudinal study of 55 obstetric clinic patients from the US Pacific Northwest region. In the third trimester of pregnancy, participants reported on epidural expectation and fear of childbirth pain. Postpartum reports included birth characteristics, satisfaction, and description of epidural uptake. Results: Of the 21 participants who expected to have an epidural, 18 (86%) did; of those who did not expect one, 6/16 (38%) did not have one. Fourteen (78%) of the 18 who expected to ‘wait and see’ had an epidural. Birth satisfaction was significantly higher in confirmed vs. violated expectation subgroups. Qualitative data identified factors potentially involved in epidural uptake expectancy violations. Conclusions: This study on expected vs. actual epidural uptake has identified specific factors in the pathway to expectancy violation such as late-term pregnancy concerns, labour onset timing, and medical induction, which has important implications for research and counselling on birth options.

Keywords:

• maternal expectations
• epidural
• childbirth
• prospective study