Factors associated with the choice of delivery without epidural analgesia in women at low risk in France.
BACKGROUND
Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women's characteristics, prenatal care, and type of maternity unit.


METHODS
The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women's choice to deliver without epidural analgesia were studied with multivariable analyses.


RESULTS
Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in non-university public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site.


CONCLUSIONS
Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor.
INSERM U149, Epidemiological Research Unit on Perinatal and Women's Health, Villejuif, France.
Camille
C
Le Ray
François
F
Goffinet
Maryse
M
Palot
Micheline
M
Garel
Béatrice
B
Blondel
D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D000776:Anesthesiology; D002755:Choice Behavior; D004651:Employment; D005260:Female; D005602:France; D006306:Health Surveys; D006757:Hospital Units; D006779:Hospitals, Public; D006801:Humans; D007745:Labor Onset; D015999:Multivariate Analysis; D010298:Parity; D036801:Parturition; D011247:Pregnancy; D012944:Social Support; D000078329:Workforce