Patient Education on Labor Analgesia Options
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 7/13/2016 |
| Start Date: | September 2015 |
| End Date: | December 2017 |
| Contact: | Antonio Gonzalez-Fiol, MD |
| Email: | gonzala6@njms.rutgers.edu |
| Phone: | 973 972-5007 |
Effects of Antenatal and Perinatal Education of Labor Analgesia Options on Maternal Anxiety, Labor Analgesia and Maternal Satisfaction With Labor Analgesia
The purpose of this study is to learn how the investigators can better educate pregnant
patients about the options open to them for pain relief during labor. Patients will receive
educational pamphlet during prenatal clinic visit and again on admission to labor and
delivery. The options for analgesia will be discussed by anesthesia care provider. Patient
will be asked to complete a survey on the post partum unit.
patients about the options open to them for pain relief during labor. Patients will receive
educational pamphlet during prenatal clinic visit and again on admission to labor and
delivery. The options for analgesia will be discussed by anesthesia care provider. Patient
will be asked to complete a survey on the post partum unit.
Many analgesic options exist for laboring parturients, but labor may not be the best time to
start informing patients of their options. Many patients begin the labor process with a plan
in place for their analgesia. Unfortunately, internet resources regarding labor analgesia
that are available to the lay parturient are poor and often lead to misconceptions about the
options and their risks. A significant number of patients refuse neuraxial analgesia based
on misunderstandings, concerns about the procedure, or a lack of faith in the provider. Some
women want a "natural childbirth" and/or control over their labor experience. Forty-seven
percent of minority women feel inadequately educated about anesthesia, are less likely to
trust physicians, and are less likely to receive epidurals. However, greater than 10% of
obese women changed their preference toward epidural analgesia following antenatal
consultation. Also, 50% of patients planning for analgesia-free labor request neuraxial
analgesia after experiencing labor pain.3 Additionally, the question exists as to the
quality of informed consent from a patient undergoing contraction pain and possible sedation
from analgesic medications. The consensus is that parturients can provide informed consent.
However, the process of informed consent for labor analgesia is not standardized; the
options and risks presented to patients are dependent upon the individual practitioner
obtaining the consent. Regarding epidurals, patients want to be informed of all risks and
complications associated with the procedure. The patient's recall of the risks and benefits
of the epidural procedure improved by 50% with written material in addition to verbal
discussion, and recall improved by more than a factor of five when consent during labor was
preceded by antenatal education. Parturients want a "pre-operative" visit with an
anesthesiologist and have a strong desire for pre-labor education of anesthesia/analgesia
options. Early antenatal education allows for time to teach, relieves anxiety, develops
rapport, and provides opportunities for additional testing, if needed. Finally, the timing
of epidural placement has not been shown to change outcomes, but when initiated late in the
labor process, often other analgesia modalities were used that confounded the analysis of
outcomes. Therefore, earlier request, which may come with prior knowledge and avoidance of
misconceptions, and earlier placement of epidurals may lead to fewer analgesic interventions
in the parturient and possibly less morbidity for the patient and fetus. The investigators
will provide information of available labor analgesia options (epidural, combined
spinal/epidural, spinal, remifentanil patient-controlled analgesia, and intravenous opioids)
to expecting mothers. Using a pamphlet written in English or Spanish disseminated to
pregnant women in clinic and upon arrival in the labor and delivery unit, the procedures and
their risks and benefits will be explained in simple terms. In the Labor and Delivery Unit
the patients will have an opportunity to ask questions of the anesthesia care giver
regarding the options for analgesia. After delivery while on F Green, patients will be asked
to complete a questionnaire addressing their thoughts about the pamphlets and their overall
satisfaction with their labor analgesia. The analysis will focus on the utility and effect
of education materials on maternal informed consent for labor analgesia, on maternal choice
of analgesia modality, and on maternal anxiety regarding their labor analgesia plan.
start informing patients of their options. Many patients begin the labor process with a plan
in place for their analgesia. Unfortunately, internet resources regarding labor analgesia
that are available to the lay parturient are poor and often lead to misconceptions about the
options and their risks. A significant number of patients refuse neuraxial analgesia based
on misunderstandings, concerns about the procedure, or a lack of faith in the provider. Some
women want a "natural childbirth" and/or control over their labor experience. Forty-seven
percent of minority women feel inadequately educated about anesthesia, are less likely to
trust physicians, and are less likely to receive epidurals. However, greater than 10% of
obese women changed their preference toward epidural analgesia following antenatal
consultation. Also, 50% of patients planning for analgesia-free labor request neuraxial
analgesia after experiencing labor pain.3 Additionally, the question exists as to the
quality of informed consent from a patient undergoing contraction pain and possible sedation
from analgesic medications. The consensus is that parturients can provide informed consent.
However, the process of informed consent for labor analgesia is not standardized; the
options and risks presented to patients are dependent upon the individual practitioner
obtaining the consent. Regarding epidurals, patients want to be informed of all risks and
complications associated with the procedure. The patient's recall of the risks and benefits
of the epidural procedure improved by 50% with written material in addition to verbal
discussion, and recall improved by more than a factor of five when consent during labor was
preceded by antenatal education. Parturients want a "pre-operative" visit with an
anesthesiologist and have a strong desire for pre-labor education of anesthesia/analgesia
options. Early antenatal education allows for time to teach, relieves anxiety, develops
rapport, and provides opportunities for additional testing, if needed. Finally, the timing
of epidural placement has not been shown to change outcomes, but when initiated late in the
labor process, often other analgesia modalities were used that confounded the analysis of
outcomes. Therefore, earlier request, which may come with prior knowledge and avoidance of
misconceptions, and earlier placement of epidurals may lead to fewer analgesic interventions
in the parturient and possibly less morbidity for the patient and fetus. The investigators
will provide information of available labor analgesia options (epidural, combined
spinal/epidural, spinal, remifentanil patient-controlled analgesia, and intravenous opioids)
to expecting mothers. Using a pamphlet written in English or Spanish disseminated to
pregnant women in clinic and upon arrival in the labor and delivery unit, the procedures and
their risks and benefits will be explained in simple terms. In the Labor and Delivery Unit
the patients will have an opportunity to ask questions of the anesthesia care giver
regarding the options for analgesia. After delivery while on F Green, patients will be asked
to complete a questionnaire addressing their thoughts about the pamphlets and their overall
satisfaction with their labor analgesia. The analysis will focus on the utility and effect
of education materials on maternal informed consent for labor analgesia, on maternal choice
of analgesia modality, and on maternal anxiety regarding their labor analgesia plan.
Inclusion Criteria:
- Postpartum women ages 18 and older
- Patients who speak and read English or Spanish
- Patients who received our informational pamphlet while pregnant or in labor
- Patients who are able to consent and make medical decisions
- Patients undergoing labor or trial of labor after cesarean delivery
- Patients who undergo cesarean delivery after trial of labor
Exclusion Criteria:
- Patients unable or unwilling to complete questionnaire
- Patients unable to consent or make medical decisions
- Patients less than 18 years of age
- Patients unable to read and speak English or Spanish
- Patients in whom any of the analgesic options were contraindicated
- Patients with a history of an anxiety disorder
- Patients with precipitous labor or late presentation that precluded an analgesic
intervention
- Patients with fetal distress that precluded an analgesic intervention
- Patients planned for elective cesarean section.
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