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Created on : 12 Nov 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Epidural analgesia use as a marker for physician approach to birth: Implications for maternal and newborn outcomes. BIRTH-ISSUES IN PERINATAL CARE, 28 (4), p.243-248 DEC

Author(s) :

Klein MC, Grzybowski S, Harris S, Liston R, Spence A, Le G, Brummendorf D, Kim S, Kaczorowski J

Year of publication :


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Résumé (français)  :

Abstract (English)  :

Background: Understanding the association between caregiver belief systems and practice patterns is an emerging area of research. We hypothesized an association between a maternity caregivers belief system and his or her behavior. The study objective was to determine if a family physician’s overall approach to maternity care, cis measured by average use of epidural analgesia, was associated with maternal and fetal outcomes.

Methods: Retrospective analysis was conducted of the births of three cohorts of 1992 nulliparous, low- risk women attended by 96 family physicians within an 18-month period in the department of family practice at the largest maternity hospital in Canada. Cohorts were based on the physicians’ mean use of epidural analgesia for the women. Family physicians attending fewer than 5 births were excluded. The main outcome measures, by, physician epidural utilization cohort, were maternal/newborn morbidity, procedure rates, consultation rates, and length of stay.

Results: Family physicians were separated into cohorts based on their mean use of epidural analgesia at rates of: low, 0-30 percent (15 physicians, 263 births); medium, 31-50 percent (55 physicians, 1323 births); and high, 51-100 percent (26 physicians, 406 births). After adjustment for maternal age and race, patients of low versus high epidural users were admitted at a later state of cervical dilation (mean 4.0 vs 3.1 cm), received less electronic fetal monitoring (76.4 vs 87.2%) and oxytocin augmentation (12.2 vs 29.8%), sustained fewer malpositions (occiput posterior or transverse)(23.2 vs 34.2%), had fewer cesarean sections (14.0 vs 24.4%), less obstetric consultation (47.9 vs 63.8%), and fewer newborn special care admissions (7.2 vs 12.8%).

Conclusions: In our setting, high use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity

Sumário (português)  :

Resumen (español)  :

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Argument (français) :

High use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity

Argument (English):

L’utilisation intensive de l’analgésie péridurale est le marqueur d’une pratique caractérisée par des mauvaises présentations qui induisent un travail dysfonctionnel et un taux plus élevé d’interventions, ce qui conduit à trop de morbidité maternelle et infantile.

Argumento (português):

Argumento (español):

Keywords :

➡ hormones ; dilation ; epidural ; dystocy ; morbidity ; maternal age

Author of this record :

Sandrine Péneau — 12 Nov 2004
➡ latest update : Bernard Bel — 02 Dec 2007

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