Why is this relevant?

Anaesthetists and anesthesiologists have long worried about the recall of labouring women when presented with risk-benefit discussions prior to epidural analgesia or receiving anaesthesia for cesarean section.

This UK survey of over 900 women across 28 Greater London hospitals explored recall of this antenatal and intrapartum information, along with maternal satisfaction.

What did they find?

There was very little recall of receiving either thorough labour analgesia information (9%) or anaesthesia for CS (12%) provided during the antenatal period.

During the interpartum period, fewer than two-thirds (62%) recalled receiving thorough information during labour before insertion, and less than one-third (28%) before Caesarean section anaesthesia.

13% of women did not recall receiving any information before epidural insertion.

These are concerning findings in a modern era where patient autonomy and informed consent are prioritised, and more so where informed decision making may contribute to a positive birth experience.

Interestingly, verbal information appeared best recalled (OR 5.9 to 20.7 across different categories), although this is counter to past studies showing superiority of written information.

Be clear

Because the 28 hospitals contributing to the survey had large practice differences in how antenatal anaesthetic information was provided, it is difficult to determine whether the provision of information or recall itself is the problem.

Take-home...

Regardless of the cause, a large proportion of pregnant women did not recall being adequately informed before epidural analgesia or caesarean anaesthesia. This needs to be improved.

summary

• R Brinkler, Z Edwards, S Abid, C M Oliver, Q Lo, A Stewart, and Pan-London Peri-operative Audit and research Network (PLAN).
• Department of Anaesthesia, University College Hospital, London, UK.
• Anaesthesia. 2019 Sep 1; 74 (9): 1101-1111.

AbstractPregnant women should receive information about what they might expect to experience during their delivery. Despite this, research shows many women are inadequately prepared for anaesthetic interventions during labour. We surveyed 903 postnatal women across 28 Greater London hospitals about: the analgesic and anaesthetic information that they recalled receiving during pregnancy and delivery; their confidence to make decisions on analgesia; and their satisfaction with the analgesia used. Wide variation was observed between hospitals. Overall, 67 of 749 (9.0%) women recalled receiving antenatal information covering all aspects of labour analgesia, and 108 of 889 (12.1%) covering anaesthesia for caesarean section. Regarding intrapartum information, 256 of 415 (61.7%) respondents recalled receiving thorough information before epidural insertion for labour analgesia, and 102 of 370 (27.6%) before anaesthesia for caesarean section. We found that 620 of 903 (68.7%) women felt well enough informed to be confident in their analgesic choices, and 675 of 903 (74.8%) stated that their analgesia was as expected or better. Receiving information verbally, regardless of provider, was the factor most strongly associated with respondents recalling receiving full information: odds ratio (95%CI) for labour analgesia 20.66 (8.98-47.53; p < 0.0001); epidural top-up for caesarean section 5.93 (1.57-22.35; p = 0.01); and general anaesthesia for caesarean section 12.39 (2.18-70.42; p = 0.01). A large proportion of respondents did not recall being fully informed before an anaesthetic intervention. Collaboration with current antenatal service providers, both in promoting information delivery and providing resources to assist with delivery, could improve the quality of information offered and women's retention of that information.© 2019 Association of Anaesthetists.

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