Labor Analgesia
Conditions
Brief summary
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.
Detailed description
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. Our study aimed at providing information and alternatives for labor analgesia in a simple written format. 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.
Interventions
patients will receive pamphlet on labor analgesia options.
Sponsors
Rutgers, The State University of New Jersey
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survey to Determine Utility and Effect of Educational Materials | expected average of no later than 48 hours following delivery | In order to assess the educational value of the pamphlet provided to parturients we evaluated all the questions pertaining education. There is no nominal value reported in units as all the data is merely described as the percentage of patients responding to educational questions. For example, 93% of patients (91/98) responded Yes to the question -Do you think the pamphlet you received did a better job explaining your options for control of labor pain than what you answered in the previous question \<patient research\>? |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Labor Pain Control Pamphlet All English or Spanish speaking patients were provided with a pamphlet during their prenatal visits and then again when entering the labor and delivery floor. The pamphlet contained information regarding labor analgesia alternatives (i.e Epidural, remifentanil PCA, morphine bolus, etc). After delivery, the patients were approached and asked to respond to a brief questionnaire. | 100 |
| Total | 100 |
Baseline characteristics
| Characteristic | Labor Pain Control Pamphlet | — |
|---|---|---|
| Age, Customized 18-45 years | 100 Participants | — |
| Patients completing survey | 100 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment United States | 100 participants | — |
| Sex: Female, Male Female | 100 Participants | — |
| Sex: Female, Male Male | 0 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Survey to Determine Utility and Effect of Educational Materials
In order to assess the educational value of the pamphlet provided to parturients we evaluated all the questions pertaining education. There is no nominal value reported in units as all the data is merely described as the percentage of patients responding to educational questions. For example, 93% of patients (91/98) responded Yes to the question -Do you think the pamphlet you received did a better job explaining your options for control of labor pain than what you answered in the previous question \<patient research\>?
Time frame: expected average of no later than 48 hours following delivery
Population: The answers from 100 female patients, ages 18-45 admitted to the L\&D who answered our survey were analyzed to gage the educational value of our labor analgesia informational pamphlet.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet better explained options for pain | 93 percentage of patients responding |
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet information helped to reduce anxiety | 90 percentage of patients responding |
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Researched options for labor pain | 79 percentage of patients responding |
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Information corrected any misconception | 71 percentage of patients responding |
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Written information should always be available | 100 percentage of patients responding |
| Yes % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet should be given before onset labor pain | 97 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Written information should always be available | 0 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Researched options for labor pain | 21 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet better explained options for pain | 7 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet should be given before onset labor pain | 3 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Pamphlet information helped to reduce anxiety | 10 percentage of patients responding |
| No % | Survey to Determine Utility and Effect of Educational Materials | Information corrected any misconception | 29 percentage of patients responding |
p-value: <0.0001Test of equal proportion (50/50)
p-value: <0.0001Test of equal proportion (50/50)
p-value: <0.0001Test of equal proportion (50/50)
p-value: <0.0001Test of equal proportion (50/50)
p-value: 0.0002Test of equal proportion (50/50)
p-value: <0.0001Test of equal proportion (50/50)