Maternal characteristics and satisfaction associated with intrapartum epidural analgesia use in Canadian women

Background: The use of epidural analgesia for intrapartum pain relief has increased over recent decades, with rates varying among developed countries. The objective of this study was to determine the socio-demographic and obstetric characteristics and satisfaction associated with epidural analgesia use for intrapartum analgesia in Canadian women. Methods: Using the Maternity Experiences Survey of the Canadian Perinatal Surveillance System, a randomly-selected sample of 5350 women who had attempted a vaginal birth was examined, representing 63900 Canadian women. Univariate and multivariate logistic regression models were used to determine the association between socio-demographic and obstetric characteristics and use of epidural analgesia. Results: The rate of epidural analgesia use was 57.3% among women with a trial of vaginal birth. Women with higher education levels (OR 1.12, 95%Cl 1.07-1.18) and higher income (OR 1.10, 95%Cl 1.05-1.14) were more likely to use epidural analgesia. Women were less likely to use epidural analgesia if they were First Nations (OR 0.77, 95%Cl 0.69-0.84), unemployed (OR 0.89, 95%Cl 0.81-0.97) or a homemaker (OR 0.86, 95%Cl 0.82-0.9), living in a rural area (OR 0.60, 95%Cl 0.57-0.63), multiparous (OR 0.32, 95%CI 0.31-0.33) and seeing a midwife, family physician or nurse for prenatal (OR 0.6, 95%CI 0.53-0.67, OR 0.71, 95%CI 0.67-0.74, OR 0.75, 95%CI 0.56-0.99, respectively) and intrapartum care (OR 0.12, 95%Cl 0.10-0.14, OR 0.58, 95%CI 0.55-0.61, OR 0.58, 95%Cl 0.54-0.63, respectively). Maternal prenatal stressors were associated with epidural analgesia use in a non-linear fashion: compared with women with zero stressful events, women with one stressful event were more likely to use epidural analgesia (OR 1.07, 95%Cl 1.02-1.12), but women with two or more events were less likely to use epidural analgesia (OR 0.88, 95%Cl 0.84-0.92). Satisfaction with labor was high, regardless of type of analgesia used. Conclusions: Socio-demographic and obstetric characteristics, combined with a high satisfaction with labor regardless of the method of pain relief, support the existence of smaller rural obstetric centers unable to provide availability of continuous epidural labor analgesia. (C) 2012 Elsevier Ltd. All rights reserved.