# Factors influencing the use of epidural labor analgesia: a cross-sectional survey analysis

## TL;DR

This study identifies personal and organizational factors affecting the use of epidural labor analgesia among women in Shanghai, China.

## Contribution

The study validates factors influencing the rejection of epidural labor analgesia and suggests interventions to improve its implementation.

## Key findings

- 355 out of 451 women initially preferred epidural labor analgesia (ELA), while 96 directly rejected it.
- Five validated factors influencing ELA rejection include multiparity, fear of back pain, prior ELA experience, attitude toward labor pain, and lack of recent blood tests.
- A predictive model for ELA rejection had 96.3% sensitivity and 69.8% specificity.

## Abstract

This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA).

This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis.

Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively.

The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers.

This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020