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Objectives  To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women’s decisions to use EDA.    Design  Longitudinal cohort study.    Setting  Akershus University Hospital, Norway.    Population  2596 women with singleton pregnancies and intended vaginal delivery.    Methods  Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward.    Main outcome measure  Preference for EDA was indicated by the questionnaire item “I would prefer an epidural regardless” on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32.    Results  Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)].    Conclusion  Fear of childbirth is significantly associated with women’s choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.

Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study