Analgesia during Labor and Vaginal Birth among Women with Severe Maternal Morbidity: Secondary Analysis from the WHO Multicountry Survey on Maternal and Newborn Health.

Publisher: Hindawi Pub. Co Country of Publication: United States NLM ID: 101600173 Publication Model: eCollection Cited Medium: Internet ISSN: 2314-6141 (Electronic) NLM ISO Abbreviation: Biomed Res Int Subsets: MEDLINE

Original Publication: New York, NY : Hindawi Pub. Co.

Internationality* ; Maternal Mortality* ; Surveys and Questionnaires* ; World Health Organization*; Analgesia/*statistics & numerical data ; Infant Health/*statistics & numerical data ; Labor, Obstetric/*physiology ; Maternal Health/*statistics & numerical data; Adult ; Female ; Humans ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome ; Prevalence ; Young Adult

Aim: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia.
Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups.
Results: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death).
Conclusions: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.

Soc Hist Med. 1997 Dec;10(3):383-400. (PMID: 11619824)
Aust N Z J Obstet Gynaecol. 2003 Dec;43(6):463-8. (PMID: 14712952)
Anesthesiology. 2007 Jan;106(1):19-25; discussion 6-8. (PMID: 17197841)
Int J Gynaecol Obstet. 2007 Sep;98(3):205-7. (PMID: 17466300)
PLoS Med. 2007 Oct 16;4(10):e296. (PMID: 17941714)
BMC Med. 2008 Mar 14;6:7. (PMID: 18366632)
Best Pract Res Clin Obstet Gynaecol. 2009 Jun;23(3):287-96. (PMID: 19303368)
Bull World Health Organ. 2009 Oct;87(10):734. (PMID: 19876533)
Best Pract Res Clin Obstet Gynaecol. 2010 Jun;24(3):303-12. (PMID: 20075008)
Natl Vital Stat Rep. 2011 Apr 6;59(5):1-13, 16. (PMID: 21553556)
Am J Obstet Gynecol. 2011 Jul;205(1):45.e1-9. (PMID: 21620366)
Cad Saude Publica. 2011 Sep;27(9):1789-800. (PMID: 21986606)
BMC Health Serv Res. 2011 Oct 26;11:286. (PMID: 22029735)
BMC Pregnancy Childbirth. 2013 Mar 26;13:78. (PMID: 23530472)
Lancet. 2013 May 18;381(9879):1747-55. (PMID: 23683641)
Bull World Health Organ. 2013 Oct 1;91(10):794-6. (PMID: 24115804)
BJOG. 2016 May;123(6):946-53. (PMID: 26412586)
Coll Antropol. 2015 Sep;39(3):557-65. (PMID: 26898050)
Lancet. 2016 Oct 29;388(10056):2164-2175. (PMID: 27642022)
Obstet Gynecol. 2017 Apr;129(4):e73-e89. (PMID: 28333819)
Semin Perinatol. 2017 Aug;41(5):293-298. (PMID: 28600029)
Obstet Gynecol. 2017 Aug;130(2):366-373. (PMID: 28697109)
Anesth Analg. 2017 Sep;125(3):925-933. (PMID: 28708666)
PLoS One. 2017 Jul 27;12(7):e0180846. (PMID: 28749944)
Women Birth. 2019 Feb;32(1):28-38. (PMID: 29685345)
Int J Gynaecol Obstet. 2018 May;141 Suppl 1:61-68. (PMID: 29851114)
Midwifery. 2018 Sep;64:110-114. (PMID: 29961561)
PLoS Med. 2018 Oct 16;15(10):e1002672. (PMID: 30325928)
Pain. 1984 Aug;19(4):321-37. (PMID: 6384895)

001 International WHO_ World Health Organization

Date Created: 20190322 Date Completed: 20190710 Latest Revision: 20220408

20240628

PMC6393865

10.1155/2019/7596165

30895195