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Background: Patient satisfaction and quality of recovery (QoR) are important patient-reported outcomes and quality metrics. The relationship between these two outcomes is complex, with studies showing a weak correlation between them in the non-obstetric population. We sought to evaluate the correlation between patient satisfaction and QoR scores in the obstetric population after caesarean delivery. As secondary aims, we aimed to determine the influence of urgency of procedure and mode of anaesthetic on patient satisfaction and QoR scores as well as determining drivers of satisfaction and dissatisfaction., Methods: Women were invited to complete the Maternal Satisfaction Scale for Caesarean Section (MSCS) and Obstetric Quality of Recovery Score (ObsQoR-11) questionnaires at 24 h after caesarean delivery. Correlations were analysed using Spearman's rank tests. Qualitative data were analyzed using thematic content analysis., Results: Data were collected from 300 women. There was a significant but weak positive correlation between ObsQoR-11 and MSCS scores (r = 0.31, P < 0.001). Correlation was significantly influenced by mode of anaesthesia (P < 0.001) and urgency of procedure (P = 0.005), with greater satisfaction amongst patients receiving spinal anaesthesia and those undergoing scheduled caesarean deliveries for a given QoR score. Quality of communication, interactions with staff and aspects of the postpartum physical environment were significant determinants of satisfaction and dissatisfaction., Conclusion: Maternal satisfaction and obstetric QoR are distinct entities with a weak correlation between the two variables. Urgency of procedure and mode of anaesthesia are significant predictors of the correlation between satisfaction and quality of recovery scores. Many of the drivers of satisfaction were modifiable including quality of communication and a comfortable physical space for postpartum recovery., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries., Objectives: To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic., Methods: We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications., Results: We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001)., Conclusions: We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.

Background: It is unknown whether the implementation of an information video on spinal anesthesia for cesarean delivery, narrated in a patient's first language, reduces anxiety, increases satisfaction, and improves doctor-patient communication if there is a language barrier. In South Africa, most doctors speak English, and patients speak Xhosa, with educational and cultural disparities existing in many doctor-patient interactions., Methods: One hundred seventy-five Xhosa patients scheduled for elective cesarean delivery were enrolled in the study. The first 92 patients received "usual care" verbal explanations of the spinal anesthesia procedure (control group); the next 83 patients watched a spinal anesthesia information video (intervention group), narrated in Xhosa. Videos were displayed using smartphones. Maternal anxiety was assessed before and after spinal explanation, using a Numerical Visual Analog Anxiety Scale (NVAAS). A difference in postexplanation NVAAS score of 1.5 points between intervention and control groups was regarded as clinically significant. Patient satisfaction was assessed using the Maternal Satisfaction Scale for Cesarean Section (MSSCS)., Results: The mean (standard deviation [SD]) age (31.5 years [5.2 years] and 32.1 years [5.4 years]) and preexplanation NVAAS score (4.2 [3.2] and 4.0 [3.0]) of the intervention and control groups, respectively, showed no difference at baseline. The mean (SD) postexplanation decrease in NVAAS score was greater in the intervention than in the control group (1.6 [3.5] vs 0.7 [2.3]; P = .046; unadjusted mean difference, 0.9 points [95% confidence interval {CI}, 0.02-1.8]). A linear regression model for the postexplanation NVAAS score showed that the intervention effect was significantly associated with the preexplanation score (P = .002), adjusted for age and English fluency. Patients with preexplanation NVAAS scores ≥5 showed a statistically significant intervention effect. There was no significant difference in patient satisfaction between the intervention and control groups. The smartphone was an accessible and convenient display medium for the video. Ninety-nine percent of patients exposed to the intervention would recommend watching the video before the procedure., Conclusions: In this pilot study, lower NVAAS scores were observed in anxious patients, when a Xhosa information video was used to ameliorate challenges posed by a doctor-patient language barrier. It is easily implemented and demonstrates a novel use of mobile health technology. The study provides baseline data to inform sample size calculations for future studies. A high level of patient recommendation for the video suggests that this is an agreeable practice.

Patient-centred care and factors associated with patient satisfaction with anaesthesia have been widely studied. However, the most important considerations in the setting of obstetric anaesthesia are uncertain. Identification of, and addressing, factors that contribute to patient dissatisfaction may improve quality of care. We sought to identify factors associated with < 100% satisfaction with obstetric anaesthesia care. At total of 4297 women treated by anaesthetists provided satisfaction data 24 h after vaginal and 48 h after caesarean delivery. As 78% of women were 100% satisfied, we studied factors associated with the dichotomous variable, 100% satisfied vs. < 100% satisfied. We evaluated patient characteristics and peripartum factors using multivariable sequential logistic regression. The following factors were strongly associated with maternal dissatisfaction after vaginal delivery: pain intensity during the first stage of labour; pain intensity during the second stage of labour; postpartum pain intensity; delay > 15 min in providing epidural analgesia and postpartum headache (all p < 0.0001). Pruritus (p = 0.005) also contributed to dissatisfaction after vaginal delivery, whereas non-Hispanic ethnicity was negatively associated with dissatisfaction (p = 0.01). After caesarean delivery, the intensity of postpartum pain (p < 0.0001), headache (p = 0.001) and pruritus (p = 0.001) were linked to dissatisfaction. Hispanic ethnicity also had a negative relationship with dissatisfaction after caesarean delivery (p = 0.005). Thus, inadequate or delayed analgesia and treatment-related side-effects are associated with maternal dissatisfaction with obstetric anaesthesia care. Development of protocols to facilitate identification of ineffective analgesia and provide an appropriate balance between efficacy and side-effects, are important goals to optimise maternal satisfaction., (© 2019 Association of Anaesthetists.)

There are various modes of anaesthesia available in the community today. This gives anaesthesiologists the freedom to select those that are safe, efficacious and most suitable for patients. However, patients may not always agree with their anaesthesiologist on the preferred mode of anaesthesia because they may have a different set of priorities, with many of them electing to have the lack of intraoperative awareness as the primary objective. Hence, disagreements between anaesthesiologists and patients may arise and could potentially disrupt doctor-patient relationship. This paper attempts to explore the possible reasons for obstetric patients championing for certain modes of anaesthesia and to provide an insight into the need for adequate patient education.

Background: Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction. We sought to compare the relationship between analgesic effectiveness and patient satisfaction with analgesia in women who delivered vaginally using nitrous oxide, neuraxial analgesia (epidural or combined spinal-epidural [CSE]), or both (neuraxial after a trial of nitrous oxide)., Methods: A standardized survey was recorded on the first postpartum day for all women who received anesthetic care for labor and delivery. Data were queried for women who delivered vaginally with nitrous oxide and/or neuraxial labor analgesia over a 34-month period in 2011 to 2014. Parturients with complete data for analgesia quality and patient satisfaction were included. Analgesia and satisfaction scores were grouped into 8 to 10 high, 5 to 7 intermediate, and 0 to 4 low. These scores were compared with the use of ordinal logistic regression across 3 groups: nitrous oxide alone, epidural or CSE alone, or nitrous oxide followed by neuraxial (epidural or CSE) analgesia., Results: A total of 6507 women received anesthesia care and delivered vaginally. Complete data were available for 6242 (96%) women; 5261 (81%) chose neuraxial analgesia and 1246 (19%) chose nitrous oxide. Of the latter, 753 (60%) went on to deliver with nitrous oxide alone, and 493 (40%) switched to neuraxial analgesia. Most parturients who received neuraxial analgesia (>90%) reported high analgesic effectiveness. Those who used nitrous oxide alone experienced variable analgesic effectiveness, with only one-half reporting high effectiveness. Among all women who reported poor analgesia effectiveness (0-4; n = 257), those who received nitrous oxide alone were more likely to report high satisfaction (8-10) than women who received epidural analgesia alone (OR 2.5; 95% CI 1.4-4.5; P = .002). Women who reported moderate analgesia (5-7) and received nitrous oxide only were more likely to report high satisfaction compared with the other groups. Among women who reported a high level of analgesic effectiveness, satisfaction with anesthesia was high and not different among groups., Conclusions: Patients who received nitrous oxide alone were as likely to express satisfaction with anesthesia care as those who received neuraxial analgesia, even though they were less likely to report excellent analgesia. Although pain relief contributes to the satisfaction with labor analgesia care, our results suggest that analgesia is not the only contributor to maternal satisfaction.

Background: Obese parturients are recognised as high risk and an antenatal anaesthetic consultation is recommended. The potential positive and negative effects of this consultation have not been investigated. This prospective observational study aimed to determine if antenatal anaesthetic consultation affects decisional conflict, anxiety scores or risk perception in obese women planning vaginal delivery., Methods: Eligible women had a body mass index of > or = 35 kg/m2, planning a vaginal delivery, aged > or = 18 years and able to complete a questionnaire presented in English. Before their anaesthetic consultation, women completed a written decisional conflict questionnaire, the Six-Point Short Form of the Speilberger State-Trait Anxiety Inventory and two questions regarding risk perception. All questions were repeated by telephone consultation two weeks later. Independent samples t-tests were used to detect differences between pre and post-test scores., Results: Of 114 women recruited, 89 completed the protocol and were analysed. Women had a mean ±SD age of 29.4±5.2 years and body mass index of 43.6±5.6 kg/m2. Decisional conflict scores were significantly lower after the consultation (30.04 vs. 16.54, P<0.001). Anxiety scores were lower (9.41 vs. 8.49, P=0.002) but this was not clinically significant. Only 19.1% of women felt their health was at risk in pregnancy; this did not change after the consultation. Thirteen women changed their preference toward epidural analgesia (P=0.01)., Discussion: Our results support the current practice of referral of obese parturients for anaesthetic consultation, but demonstrate that most women remain unaware of the risks of obesity in pregnancy despite anaesthetic consultation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Video-based patient information supplementing clinician interview has been shown to reduce anxiety and improve satisfaction in patients undergoing procedures. In Queensland more than 90% of caesarean sections are performed under regional anaesthesia. We aimed to assess the effect of using an information video about neuraxial blockade in patients having regional anaesthesia for elective caesarean section. Subjects were randomised to undergo usual care (Group C), or to view a video and undergo usual care (Group V). Subjects completed the Spielberger State-Trait Anxiety Inventory preoperatively and the Maternal Satisfaction with Caesarean Section Score questionnaire postoperatively. Satisfaction with, and duration of the preoperative anaesthetic interview, were noted. One-way analysis of variance (ANOVA) and Chi-squared tests were used in statistical analysis. One-hundred and forty three subjects were randomised and 110 completed the protocol and analysis. Group C and Group V were similar in terms demographic and anaesthesia data. There was no difference in anxiety score (41.2 versus 39.8, P=0.50), maternal satisfaction score (118.5 versus 122.7, P=0.22) or interview duration (16.3 versus 15.8 min, P=0.69) between the two groups. The use of an anaesthesia information video does not reduce preoperative anxiety or increase the duration of the anaesthetic interview. Maternal satisfaction with neuraxial blockade for elective caesarean is high and not improved by an anaesthesia information video.

Patient consent for obstetric analgesia and anesthesia involves several confounding issues in addition to the basic elements of consent. These include capacity during active labor, maternal-fetal conflict, and the care of pregnant minors. In this review, we focus on these unique consent issues. Despite pain and anxiety, women maintain the capacity to understand and recall information imparted during labor. Anesthesia providers generally disclose high-frequency and high-morbidity side effects and complications. The use of written materials and early antenatal education may improve retention of information and maternal satisfaction. Successful navigation of the consent process requires knowledge of the guidelines and laws that govern each provider's individual jurisdiction.

Background: This study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner's presence during neuraxial anesthesia placement affected patients' overall anxiety levels., Methods: Three hundred fifteen patient-partner dyads were randomized to two groups: group 1 partners were present in the operating room during neuraxial anesthesia placement while group 2 partners remained outside the operating room during placement. Before surgery, all patient-partner dyads completed a survey of demographics, anesthetic experiences and baseline anxiety. Anxiety levels were rated using a visual analogue scale (VAS) and the state portion of the Spielberger State-Trait Anxiety Inventory., Results: The mean change in anxiety as measured by VAS among patients whose partners were present in the operating room for neuraxial anesthetic placement decreased from before to after the procedure (-4.5+/-25.8; P=0.03; 95% CI -8.55, -0.45); the mean change in anxiety in patients whose partners were not present did not alter significantly (+1.9 +/- 25.3; P=0.34; 95% CI 6.68, 12.12). Anxiety was increased among partners who were not present (+9.4, P<0.001)., Conclusion: Although patients whose partners were present in the operating room at the time of neuraxial anesthesia placement reported less anxiety over the time of the study than did patients whose partners were not present, these differences were small and are not considered to be clinically important. Increased anxiety among partners who were not present at neuraxial placements warrants further study.

Background: Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia., Methods: Multiparous women in labour were randomised to receive either paracervical block or single-shot spinal analgesia. Pain was quantified using a numerical rating scale. Subsequent analgesia, progress of labour, and mode of delivery were noted. Fetal heart rate patterns were reviewed. Apgar scores and umbilical artery pH measurements were collected. Parturients' satisfaction and willingness to have the same method of labour analgesia again were recorded., Results: 122 parturients were randomised with data available on 104. Median pain scores decreased significantly in both groups; this was greater with single-shot spinal analgesia (difference between means 2.7; 95% CI 1.9-3.5; P(g)<0.001). Parturients receiving paracervical block received subsequent analgesia more often (23/56 vs. 3/48, P<0.001). Progress of labour, instrumental delivery rates, detected abnormal decelerations in cardiotocography and neonatal outcome were similar between groups. Shivering (P<0.04) and pruritus (P<0.001) were more common with single-shot spinal analgesia. Parturients in the paracervical block group were less satisfied (median 7.0, IQR 3.0-8.0 vs. median 9.0, IQR 8.0-10.0; P<0.001) and less willing (28/55 vs. 39/48, P=0.002) to have the same labour analgesia again., Conclusions: Paracervical block was less effective than single-shot spinal analgesia. Both methods were associated with a low incidence of fetal bradycardia but maternal side effects were more common with single-shot spinal analgesia.

Background: Pain relief is an integral part of labor management. Epidural analgesia is the most effective form of pain relief, but in most Nigerian obstetric units it is not available. There is little information on the views of pregnant women about epidural analgesia during labor., Methods: A cross-sectional survey using a structured questionnaire was conducted in the antenatal clinic of University College Hospital, Ibadan, Nigeria to assess women's views about epidural analgesia., Results: Of the 650 women surveyed, 523 (80.5%) had knowledge of labour pain while only 127 women (19.5%) were aware of epidural analgesia. Knowledge was affected by parity. Awareness of epidural analgesia was related to occupational status (OR 11.00, 95% CI 5.31-22.83) and having previously experienced childbirth on one previous occasion (OR 1.75, 1.05-2.92). A total of 103 (15.8%) respondents wanted to receive epidural analgesia in their next labor. Occupation (P=0.006), knowledge of epidural analgesia (P=0.017) and previous use (P<0.001) significantly influenced desire for epidural analgesia but only knowledge (OR 2.4 95% CI 1.4-4.3) and previous use (OR 5.3 95% CI 2.1-13.5) were of statistical significance on multivariate analysis., Conclusion: This study shows that the knowledge of labor epidural analgesia amongst Nigerian women is low. Despite limited availability, women who are aware of epidural analgesia and those who have received it in a previous labor were more likely to want it in their forthcoming labor. Some women may refuse its use despite their knowledge.

Objectives: To evaluate patient attitudes about epidural services in labour and correlate them with patient options and actual usage of epidural analgesia., Design: Questionnaire survey., Setting: Eight Hospital Authority obstetrics units., Participants: A cohort of new antenatal patients and a cohort of postnatal in-patients over 1 calendar month., Main Outcome Measures: Antenatal patient awareness of epidural services and attitudes towards epidural analgesia during labour; the actual usage of such analgesia and the reported experience of postnatal patients., Results: A total of 2109 and 2851 patients completed the antenatal and postnatal survey, respectively. The former revealed that only 47% of patients had been exposed to the concept of epidural analgesia in labour, and only 13% opted for such analgesia. In the postnatal cohort, the overall epidural analgesia rate was 10%, although 19% had actually requested it. Patients who received epidural analgesia in labour were more likely to consider their experience as favourable (85%) compared to those who went through labour without such analgesia (26%) [P<0.001]. There was no significant improvement in knowledge about epidural analgesia among postnatal as compared to antenatal patients. The main reasons generally ascribed by patients for not being able to obtain an epidural service despite it being requested, were related to limited resources., Conclusion: The results showed poor general awareness of pregnant women about the proper role of epidural analgesia in labour, leading to a low patient demand for such services. Despite the low prevailing request rate for epidural analgesia in labour, there appears to be a lack of adequate resources to meet the demand.

Objectives: The purpose of this study was to examine the obstetric anesthesia method used, based on the patient's age. Confounding variables analyzed were the effect on labor pain management choices of parity, race, prenatal care participation, insurance status, and length of labor., Methods: This was a case control study from the Medical University of South Carolina (MUSC). The primary outcome measured was regional anesthesia (RA) use in labor. The exposure groups were based on the patient's age. All women aged 11 years and older who delivered vaginally from 1996 to 2001 were included; 7,583 patients met inclusion criteria. Results were analyzed using chi2 statistic, univariate analysis, ANOVA, and logistic regression., Results: We found that primiparous adolescents used RA less than primiparous women over age 20. This association is not found in multiparous teens. Patients with shorter labors, black women, those without prenatal care, and older patients lacking private insurance declined RA more often., Conclusions: RA is the most utilized form of obstetric pain management in the last decade. In primiparous adolescents, declining RA cannot be explained by length of labor, race, insurance status, or prenatal care participation.

Labor and birth, although viewed as a normal physiological process, can produce significant pain, requiring appropriate pain management. Systemic analgesia and regional analgesia/anesthesia have become less common, whereas the use of newer neuraxial techniques, with minimal motor blockade, have become more popular. Low- and ultra-low-dose epidural analgesia, spinal analgesia, and combination spinal-epidural analgesia have replaced the once traditional epidural for labor. The shift from regional anesthesia during labor, in which the woman became a passive participant during the labor and birth, to a collaborative approach for pain management, in which the woman becomes an active participant, has resulted in a new philosophy of labor analgesia. This article provides a review of the current systemic analgesics and regional and neuraxial analgesia/anesthesia techniques for pain management in labor and birth. Also addressed are implications for perinatal nurses who participate in pain management choices during labor and birth.

We investigated the correlation between the scores attained on computerised psychometric tests, measuring psychomotor and information processing aptitudes, and learning obstetric epidural anaesthesia. Ten anaesthetic trainees performed an adaptive tracking task (ADTRACK 3) and one information management task (MAZE) from the MICROPAT testing system. They then embarked on a standardised obstetric anaesthesia training programme prior to performing obstetric on-call duties. The success or failure of their first 50 obstetric epidurals was recorded. There was a significant correlation between mean obstetric epidural failure rate for the second 25 consecutive epidurals and ADTRACK 3 (r = -0.579, p = 0.04) scores. The correlation between the means of the first 25 and 50 consecutive epidurals and ADTRACK 3 scores was not significant. There was no significant correlation between epidural failure rate and MAZE scores. The ratios of the mean epidural failure rate for the last 25 epidurals to the mean for the first 25 epidurals were not significantly correlated with ADTRACK 3 or MAZE scores. Psychomotor abilities appear to be poor determinants of trainees' initial proficiency at obstetric epidural anaesthesia or of trainees' rates of progress during early obstetric epidural training, but may be determinants of an individual's performance after the initial training phase.

We induced spinal anaesthesia in 100 women presenting for elective Caesarean section with the mother in the right lateral position. Patients were allocated randomly to have the side eye of the 24-gauge Sprotte spinal needle pointing in one of four directions: group A, cephalad; group B, right lateral; group C, left lateral; group D, caudad. Isobaric bupivacaine 0.5% (2.5 ml) was injected over 30 s before the mother was placed supine with a 15 degree left lateral tilt. Onset time and height of the subsequent analgesic and anaesthetic blocks were assessed by a blinded observer. Onset of sensory block to T4 was significantly faster in group A (P = 0.001). There were no differences in final block height, incidence of hypotension, nausea and vomiting or ephedrine requirements.

The objective of the study was to investigate the sociodemographic and psychological factors which are associated with choice or refusal of regional anesthesia for lower segment Caesarean section. A semi-structured questionnaire was administered preoperatively to consecutive women presenting for elective operation at two hospital sites in the same health authority. The questionnaires were administered to 39 pregnant women by two anesthetists, one at each site. Sociodemographic and past and present obstetric and anesthetic details were obtained. The Hospital Anxiety and Depression scale and the FEAR questionnaire were used with an additional visual analog scale to assess fearfulness associated with the proposed operation. A 'panic checklist' of ten items was also constructed to identify procedures associated with feelings of panic. Ten women requested general anesthesia. These women had a similar level of anxiety to the others, but were significantly more depressed, had had more pregnancies overall and more without live babies. There were also more aspects of the procedure at which they thought they might panic. Women who have suffered the loss of a conception with its associated grief and often obstetric intervention are more reluctant to be conscious during an operative delivery for a subsequent baby. Preventive measures should be considered at the time of fetal loss to avoid this. However, preoperatively a simple visual analog scale for fearfulness would identify these women so that any unresolved fears could receive full psychological assessment.

One hundred obstetric patients presenting for elective surgery who had refused regional anaesthesia were interviewed just prior to entering the operating room. In each case, the reason for refusing a regional technique was recorded. The most frequent reasons given were fear of backache (33%) and fear of the needle (28%). Anaesthetists should be aware of patients' concerns and be able to discuss the relevant issues.

Forty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in either the sitting or right lateral positions; 2.5 ml 0.5% hyperbaric bupivacaine was injected over 10 s before the mother was placed in a supine position with a 20 degree lateral tilt. The onset time and height of the subsequent analgesic and anaesthetic block was measured. It took longer to site spinal needles in the lateral position (240 vs 115 s, p < 0.001). There was a faster onset of sensory block to the sixth thoracic dermatomal level (8 vs 10 min, p < 0.001), in the lateral group, although onset time to T4 was comparable. There was no difference in maximum block height or degree of motor block. Mothers in the lateral group required more ephedrine in the first 10 m after siting the spinal (13.5 vs 10.5 mg, p < 0.05).

The authors base their remark on a few cases of awareness which have been reported in their hospital and on the history a patient who experienced intraoperative awareness during cesarean section. Attention is focused on the ethical, social and medico-legal aspects of this phenomenon. Awareness may severely affect the patient's psychic equilibrium with the consequent onset of severe neuroses leading to the possibility of legal action and claims for compensation. Clinical experience has shown that the use of halogenate anesthetics, even in low concentrations, may help to avoid this phenomenon. Correct relations between the anesthetist and patient before and after surgery may also, even in the event of awareness, reduce the incidence and severity of consequent psychological sequelae.

Objective: To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women., Design: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy., Subjects: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included., Setting: Aberdare District Maternity Unit, Mid Glamorgan, Wales., Intervention: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy., Outcome Measures: Analgesic requirements, duration of first and second stages of labour., Results: The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P < 0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P < 0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P < 0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P < 0.001) in both hypnotised groups compared with their controls., Conclusion: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.

Perception of the birth experience was examined in a sample of 106 women who had unplanned cesarean deliveries, 113 who had planned cesarean deliveries, and 254 who had vaginal deliveries. Vaginally delivered women had more positive perceptions than their unplanned cesarean counterparts (p < .001). There were no differences in perceptions between the unplanned and planned cesarean groups, or between the planned cesarean and vaginal groups. General anesthesia for cesarean delivery was associated with more negative perceptions than regional anesthesia, and regional anesthesia for vaginal delivery was associated with more negative perceptions than no or local anesthesia. Pain intensity and physical distress were negatively correlated with perceptions.

Between 1982 and 1989 over 3000 patients were questioned about recall and dreaming after general anaesthesia for Caesarean section. Some 28 (0.9%) patients were able to recall something of their operation and 189 (6.1%) reported dreams. There was uniform adherence to a rigid anaesthetic protocol up to and including 1985, but a much publicized incident reported from the courtroom stimulated a relaxation of this regimen. Consequently the incidence of awareness decreased from 1.3% to 0.4%, and the incidence of dreaming was also reduced. Recollections of surgery were confined to manipulations, noises and voices. None of our patients complained of pain at the time of interview, although one since has. The inadequacies of the initial protocol and an approach to informed consent are discussed.

Seventy-four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p less than 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. All patients were monitored for awareness using the isolated forearm technique and lower oesophageal contractility. Provoked lower oesophageal contractility was the most effective of the different indices. A value greater than 35 mmHg on at least one occasion had a false negative rate of 33%, a false positive rate of 28% and a predictive value of 25%. A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the 'aware' patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.

This study reported on a sample of 294 first-time mothers. Fifty-six women who delivered by cesarean birth perceived their childbirth experience more negatively than those who delivered vaginally. However, the type of delivery accounted for only 1% of the variance when entered with 24 other psychosocial and obstetrical variables for stepwise multiple regression analysis. Mate emotional support contributed 20% and early maternal-infant interaction contributed 9.8% of the variance, with total positive self-concept, fewer medical complications, informative support, instrumental support, and type of delivery accounting for the remainder of the total 39%.