# Is induction of labor associated with poorer maternal satisfaction on labor analgesia? A retrospective study of deliveries with neuraxial analgesia in Helsinki University Hospital delivery units, Finland, 2022

## TL;DR

Inducing labor is linked to lower maternal satisfaction with pain relief, especially when using neuraxial analgesia, according to a study in Finland.

## Contribution

This study identifies induction of labor as a risk factor for poor analgesia satisfaction and highlights modifiable factors like timing of analgesia.

## Key findings

- Induced labor was associated with a 19% higher risk of poor analgesia satisfaction compared to spontaneous labor.
- Earlier neuraxial analgesia and fewer additional risk factors were linked to better satisfaction outcomes.
- Fear of childbirth and cesarean delivery were significant factors worsening satisfaction in induced labor.

## Abstract

The association of induction of labor with poor maternal satisfaction on analgesia is retrospectively studied in a cohort of parturients delivering with neuraxial analgesia.

Satisfaction on analgesia was measured within 1–2 days postpartum and considered as poor (<8/10), fair to good (8–9/10), or excellent (10/10). The incidence of poor maternal analgesia satisfaction was compared by logistic regression following induced (n=2654) or spontaneous onset (n=5222) labors in parturients who delivered with neuraxial analgesia in Helsinki, Finland area hospitals in 2022. Body mass index (BMI), primiparity, diagnosed fear of childbirth (FOC), other modes of labor analgesia, partogram data, and labor outcome were accounted for as cofactors. The association of cofactors within induced cohort was studied by ordinal regression.

The incidence of poor analgesia satisfaction was 24.5% and 19.5% following induction of labor and spontaneous labor, respectively. Adjustment for cofactors (BMI, primiparity, FOC, additional analgesia, cervical dilatation at the time of neuraxial analgesia, intrapartum cesarean delivery) resulted in an AOR for poor satisfaction of 1.19 (95% CI: 1.06–1.34, p<0.001), following induced labor versus spontaneous onset labor. During induced labor, FOC (AOR=1.25; 95% CI: 1.03–1.52), prior opioid labor analgesia (AOR=1.27; 95% CI: 1.09–1.48), cervical dilatation (cm) at the time of neuraxial analgesia (AOR=1.07; 95% CI: 1.02–1.12) and labor resulting in operative vaginal (AOR=1.30; 95% CI: 1.05–1.60) or cesarean delivery (AOR=1.30; 95% CI: 1.06–1.59) were found to be associated with worsening satisfaction, using ordinal regression.

Induction of labor is associated with higher risk of poor satisfaction on analgesia, and in particular with neuraxial analgesia. Earlier provision of neuraxial analgesia may help mitigate the risk, particularly when additional risk factors are present.