Epidural Anesthesia Changing Birth Practices in China

Giving women the option of having an epidural during labor has helped to lower the high rates of cesarean delivery (C-section) in China, according to a new study.

Researchers at Northwestern University (Chicago, IL, USA) conducted a study to evaluate the results of the “No Pain Labor N' Delivery” initiative at the Shijiazhuang Gynecology and Obstetrics Hospital (Hebei, China) that implemented an epidural service that was initially offered on weekdays from 08:00 to 17:30, but eventually moved to a 24/7 operation. During the study period (August 2009 to August 2011), a total of 19,938 deliveries were performed. The researchers evaluated the impact of the availability of epidural labor analgesia on the rate of cesarean delivery at the hospital.

The results showed that the rate of C-section delivery fell from 47% to 30% after the introduction of the program, driven largely by a 13% reduction in non-medically-necessary C-section. Medically indicated cesarean rates did not change, hovering at around 30%. During the study period, epidural rates rose from less than 1% to 59%; having an epidural also appeared to improve outcomes for newborns, as the incidence of 5-minute Apgar score below 3 fell from 1.4% to 0.9%. Rates of maternal death and hemorrhage were unaffected. The study was presented as a poster session at the American Society of Anesthesiologists (ASA) annual meeting, held during October 2012 in Washington DC (USA).

“Our mission reinforces the concept that providing epidural analgesia is more than just the procedure itself,” said lead author and study presenter Ling Qun Hu, MD. “The mission continues to expand its scope by visiting new Chinese hospitals every year and we hope that our contributions will improve the health of mothers and babies, first in China, and then elsewhere.”

Another effect of the initiative was the rising popularity of the hospital, with monthly birth rates at the facility rising from 757 to 1,056, which prompted the hospital to build a separate labor and delivery wing. This was despite the fact that patients had to pay out-of-pocket for the anesthesia because there was no diagnosis code for it at the time. The program has since expanded to 10 other hospitals in China and is expected to be implemented in an additional four hospitals by the end of 2013.

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