MORE WOMEN OPT FOR PAIN RELIEF DURING LABOR
Joy L. Hawkins, M.D. ASA ANNUAL MEETING
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DALLAS -- The demand for pain relief during labor and delivery by women is growing, and hospitals are doing an increasingly good job of satisfying that demand, according to the results of a survey presented at the annual meeting of the American Society of Anesthesiologists.
Researchers from the University of Colorado School of Medicine at Denver surveyed 750 hospitals nationwide regarding obstetric anesthesia staffing, availability and choices. An update of data collected in 1981 and 1992, the survey tracks key trends in obstetric anesthesia care. The researchers grouped hospitals according to the number of births per year (1,500 or more, 500-1,499 and less than 500).
The use of regional analgesia (epidural, spinal or combined spinal-epidural techniques) for labor shows no signs of slowing, the survey revealed. In larger hospitals, the use of regional anesthesia tripled during the 15 years from 1981 to 1997. Sixty-six percent of women in the largest hospitals received regional analgesia in 1997 versus 55 percent in 1992 and 22 percent in 1981. The percentage of women receiving regional analgesia in smaller hospitals nearly doubled in five years from 21 percent in 1992 to 42 percent in 1997.
"In 1997, only a range of 11 percent to 17 percent of women in the three groups received no labor analgesia of any kind at all," Joy L. Hawkins, M.D., director of obstetric anesthesia at the University of Colorado School of Medicine at Denver, said. The biggest change occurred in the smallest hospitals. In 1992, 33 percent of women in this group received no labor analgesia; in 1997, the number had fallen to 17 percent.
The survey also revealed another positive trend: the growing use of regional anesthesia instead of general anesthesia for cesarean section (c-section) deliveries. Ninety-two percent of women who had c-sections received regional anesthesia instead of general anesthesia in 1997, compared to 89 percent in 1992 and 62 percent in 1981.
Widely considered safer than general anesthesia, regional anesthesia reduces complications and blood loss, Dr. Hawkins said. "Regional anesthesia also enables women to be awake and spouses to be present for the delivery and allows mothers to bond and breastfeed sooner because they are less sedated and have better postoperative pain control," Dr. Hawkins said.
The increasing popularity of regional anesthesia for labor means women are more likely to already have an epidural catheter (tube inserted into the space adjacent to the spinal canal) in place should the obstetrician decide that a c-section delivery is needed. To provide effective anesthesia, the anesthesiologist simply increases the concentration of anesthetic delivered through the same catheter.
In addition, regional anesthesia can be performed quickly, even for many urgent cases. The development of ultra-fine needles also makes regional anesthesia a more attractive option because it reduces the incidence of headaches, once a common side effect, to less than 1 percent.
More thorough obstetric coverage by anesthesiologists has supported the growth of regional anesthesia for normal and c-section deliveries, the researchers contend. "Better coverage increases availability and use," Dr. Hawkins said.
At the same time, the responsibility for virtually all obstetric anesthesia care now falls to anesthesiologists. In 1981, obstetricians in the larger hospitals provided 26 percent of labor epidurals and 3 percent of c-section epidurals. In 1997, obstetricians provided virtually none of the anesthesia care for labor or c-section deliveries.
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