Newswise — As pain control options for labor and delivery become more varied and sophisticated, growing numbers of women are taking advantage of pain relief for their childbirth, according to a new study in the September issue of the journal Anesthesiology, the official journal of the American Society of Anesthesiologists (ASA).
Researchers from the Department of Anesthesiology at the University of Colorado at Denver and Health Sciences Center looked at survey responses from 378 hospitals that provided obstetric services in 2001, grouping the hospitals according to the number of births per year (1,500 or more, 500-1,499 and fewer than 500). They found that only 6 to 10 percent of mothers had no pain relief (analgesia) during labor in 2001, compared to 11 to 33 percent in 1992. Hospitals doing more deliveries generally had fewer mothers going without anesthesia in both years.
"Mothers have come to expect the kind of pain relief provided by regional techniques. With recent studies showing that having this type of anesthesia early in labor will not increase chances of a cesarean delivery, I think their popularity will continue," said lead author Brenda Bucklin, M.D., associate professor of anesthesiology at UCDHSC.
As women have embraced techniques that can make them more comfortable for more of their labor, demand for anesthesia services in hospitals is growing as well. Most anesthesia for labor and Cesarean delivery was directly provided or supervised by anesthesiologists. In hospitals providing care for 1,500 or more births during 2001, an anesthesiologist was involved in 95 percent of cases. Other providers of anesthesia care include certified registered nurse anesthetists and, in a very small percentage of cases, obstetricians.
Regional analgesia, including epidural, spinal or combined epidural-spinal techniques, accounted for 76 percent of the anesthesia services provided in the larger hospitals, and for 57 percent of services in the smaller hospitals. These figures represent a significant increase since 1992. Mothers are less likely to receive parenteral narcotics (drugs injected into the blood stream) as their only source of pain relief. The survey also revealed that the use of spinal anesthesia increased for cesarean section (C-section) deliveries, but use of epidural anesthesia decreased. General anesthesia was still being used in 15 to 30 percent of emergency C-sections.
Other trends revealed in the survey data:
"¢ Although the number of anesthesia providers has not kept pace with increasing demand for services overall, there has been improvement in the availability as well as staffing of regional pain relief for labor and delivery."¢ The total number of hospitals providing obstetric services has decreased, but the number of larger hospitals providing such services has increased."¢ Only 18 to 35 percent of hospitals utilized patient-controlled analgesia for labor in 2001, possibly because of unfamiliarity with, or cost of, the devices.
"The survey results suggest that the availability of services and anesthesia personnel has improved," Dr. Bucklin noted. "That is positive news for women of childbearing age."
This study was conducted with support from the Society for Obstetric Anesthesia and Perinatology (http://www.soap.org).
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