title: A qualitative analysis of parturients' perspectives on neuraxial labor analgesia.
abstract: BACKGROUND
  The decision to use, or not use, neuraxial analgesia is complex and likely multi-factorial. The objectives of this study were to understand parturients' concerns about neuraxial analgesia, and the reasons for not anticipating the use of neuraxial analgesia using qualitative methodology.
  
  
  METHODS
  English-speaking, term parturients, who had not requested or received labor analgesia, were recruited for this mixed-methods study. In addition to a quantitative survey, the results of which have been published elsewhere, women were asked open-ended questions regarding concerns about neuraxial analgesia and reasons for not anticipating its use. Answers were recorded verbatim and analyzed using qualitative methodology.
  
  
  RESULTS
  Interviews were conducted with 509 women. Thirty-nine percent of patients expressed some concern about neuraxial analgesia. These concerns were thematically represented by misunderstandings about neuraxial analgesia, general fears about the procedure, and lack of trust in providers. Many of the concerns were misunderstandings that were not supported by the medical literature. Of the 129 patients who did not anticipate using neuraxial analgesia, 23% stated that this was because they desired a natural childbirth and/or control over their labor experience, whereas 46% cited concerns about the procedure and its complications as the basis for their decision.
  
  
  CONCLUSIONS
  Many women who anticipate not using neuraxial analgesia may be basing their decision on an inaccurate understanding of the risks of the procedure. Improved patient education and counseling that target specific areas of concern may address these misunderstandings.
authors: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. p-toledo@md.northwestern.edu
authors: P
authors: P
authors: Toledo
authors: J
authors: J
authors: Sun
authors: F
authors: F
authors: Peralta
authors: W A
authors: WA
authors: Grobman
authors: C A
authors: CA
authors: Wong
authors: R
authors: R
authors: Hasnain-Wynia
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000523:psychology; D001290:Attitude; D003625:Data Collection; D005239:Fear; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000523:psychology; D009321:Natural Childbirth; D009407:Nerve Block / Q000009:adverse effects / Q000523:psychology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy; D035502:Trust