Predictors of recommendation and acceptance of intrapartum epidural analgesia

We conducted this prospective study to characterize the obstetric and socio demographic variables that predict physicians' recommendations and patients ' acceptance of intrapartum epidural analgesia. The study population consis ted of 447 consecutive, low-risk parturients in early active labor. Epidura l analgesia was recommended to 393 patients (87.9%), however only 164 (41.7 %) consented to receive it. A multiple logistic regression analysis demonst rated that the severity of pain, as assessed by the medical staff (odds rat io [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0 .57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99 ) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients' being secular compared wi th religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent pre dictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between partu rients who accept and those who do not accept this analgesia. Implications: We studied the factors that influence the recommendation of epidural analg esia by obstetricians, as well as its acceptance by the laboring patients a t a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who pe rceived greater pain were more secular, had low parity, and had a higher le vel of education were more likely to accept it.