Women's perception of the onset of labour and epidural analgesia: a prospective study.
OBJECTIVE
childbearing women and their midwives differ in their diagnoses of the onset of labour. The symptoms women use to describe the onset of labour are associated with the process of labour. Perinatal factors and women's attitudes may be associated with the administration of epidural analgesia. Our study aimed to assess the correlation between women's perception of the onset of labour and the frequency and timing of epidural analgesia during labour.


METHODS
prospective cohort study.


METHODS
41 maternity units in Lower Saxony, Germany.


METHODS
549 nulliparae (as defined in the "Methods" section) and 490 multiparae giving birth between April and October 2005. Women were included after 34 completed weeks of gestation with a singleton in vertex presentation and planned vaginal birth.


METHODS
the association between women's symptoms at the onset of labour and the administration of epidural analgesia - frequency, timing in relation to onset of labour and cervical dilatation - was assessed. The analysis was performed by Kaplan-Meiers estimation, logistic regression and Cox regression.


RESULTS
a total of 174 nulliparae and 49 multiparae received epidural analgesia during labour. Nulliparae received it at a median time of 5.47hrs (range: 0.25-51.17hrs) after onset of labour, at a median cervical dilatation of 3.3cm (range: 1.0-10.0cm). In multiparae, epidural analgesia was applied at a median time of 3.79hrs (range: 0.42-28.55hrs) after onset of labour; the median cervical dilatation was 3.0cm (range: 1.0-8.0cm). Women who were admitted with advanced cervical dilatation received epidural analgesia less often. Women who defined their onset of labour earlier than it was diagnosed by their midwives received epidural analgesia earlier. Gastrointestinal symptoms and irregular pain at the onset of labour were associated with later administration of epidural analgesia. Induction of labour was associated with a reduced interval from the onset of labour to epidural analgesia.


CONCLUSIONS
women's self-diagnosis of the onset of labour and their perception of their labour duration when meeting their midwives has some impact on their admission to the labour ward and the timing of epidural analgesia.


CONCLUSIONS
consideration of women's own perceptions and expectations regarding the onset and process of labour is necessary for individual care during labour.
Midwifery Research and Education Unit, Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany. Petersen.Antje@mh-hannover.de
Antje
A
Petersen
Sarah M
SM
Penz
Mechthild M
MM
Gross
D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D016362:Analgesia, Obstetrical / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D007745:Labor Onset / Q000502:physiology / Q000523:psychology; D048949:Labor Pain / Q000188:drug therapy / Q000523:psychology; D008880:Midwifery / Q000379:methods / Q000706:statistics & numerical data; D010298:Parity; D057240:Patient Preference / Q000706:statistics & numerical data; D010465:Perception / Q000502:physiology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D011446:Prospective Studies; D013997:Time Factors