Women's and men's negative experience of child birth-A cross-sectional survey.

BACKGROUND: A negative birth experience may influence both women and men and can limit their process of becoming a parent. AIMS: This study aimed to analyze and describe women's and men's perceptions and experiences of childbirth. DESIGN: A cross-sectional study of women and their partners living in one Swedish county were recruited in mid pregnancy and followed up two months after birth. Women (n=928) and men (n=818) completed the same questionnaire that investigated new parents' birth experiences in relation to socio-demographic background and birth related variables. RESULTS: Women (6%) and men (3%) with a negative birth experiences, experienced longer labours and more often emergency caesarean section compared to women (94%) and men (97%) with a positive birth experience. The obstetric factors that contributed most strongly to a negative birth experience were emergency caesarean and was found in women (OR 4.7, 95% CI 2.0-10.8) and men (OR 4.5, Cl 95% 1.4-17.3). In addition, pain intensity and elective caesarean section were also associated with a negative birth experiences in women. Feelings during birth such as agreeing with the statement; 'It was a pain to give birth' were a strong contributing factor for both women and men. CONCLUSIONS: A negative birth experience is associated with obstetric factors such as emergency caesarean section and negative feelings. The content of negative feelings differed between women and men. It is important to take into account that their feelings differ in order to facilitate the processing of the negative birth experience for both partners.

Presence and process of fear of birth during pregnancy-Findings from a longitudinal cohort study.

BACKGROUND: The prevalence of fear of birth has been estimated between 8-30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear. AIM: to assess the prevalence and characteristics of women presenting with scores ≥60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors. METHODS: A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at ≥60. FINDINGS: The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors. CONCLUSIONS: More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it.

The meaning of a very positive birth experience: focus groups discussions with women.

BACKGROUND: The experience of giving birth has long-term implications for a woman's health and wellbeing. The birth experience and satisfaction with birth have been associated with several factors and emotional dimensions of care and been shown to influence women's overall assessment. Individualized emotional support has been shown to empower women and increase the possibility of a positive birth experience. How women assess their experience and the factors that contribute to a positive birth experience are of importance for midwives and other caregivers. The aim of this study was to describe women's experience of a very positive birth experience. METHOD: The study followed a qualitative descriptive design. Twenty-six women participated in focus group discussions 6-7 years after a birth they had assessed as very positive. At the time of the birth, they had all taken part in a large prospective longitudinal cohort study performed in northern Sweden. In the present study, thematic analysis was used to review the transcribed data. RESULTS: All women looked back very positively on their birth experience. Two themes and six sub-themes were identified that described the meaning of a very positive birth experience. Women related their experience to internal (e.g., their own ability and strength) and external (e.g., a trustful and respectful relationship with the midwife) factors. A woman's sense of trust and support from the father of the child was also important. The feeling of safety promoted by a supportive environment was essential for gaining control during birth and for focusing on techniques that enabled the women to manage labour. CONCLUSION: It is an essential part of midwifery care to build relationships with women where mutual trust in one another's competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman's ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child.

Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment.

BACKGROUND: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. METHOD: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. RESULTS: Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours.Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P <0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5). CONCLUSIONS: There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not.

Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden.

OBJECTIVE: An instrumental vaginal birth is known to affect women's birth experience, few studies have explored the fathers' experiences of attending such a birth. The aim of this study is to compare birth outcome and parents' feelings in parents with instrumental vaginal birth or a spontaneous vaginal birth. METHODS: A regional survey was conducted of 936 mothers and 827 fathers recruited in mid-pregnancy and followed up 2 months after birth. Data was collected by questionnaires. Crude and adjusted odds ratios with a 95% confidence interval were used in the analysis. RESULTS: The prevalence for instrumental vaginal birth was 9%. Prolonged labour (OR 8.3; 95% CI 5.0-13.9), augmentation with synthetic oxytocin (OR 5.1; 2.9-8.9), and birth complications (OR 2.5; 1.5-2.6) were more common in the instrumental vaginal group. An instrumental vaginal birth was associated with a negative birth experience for mothers (OR 3.2; 1.3-8.1) and fathers (OR 5.2; 1.2-21.5). Mothers who had an instrumental vaginal birth were more likely to report feelings that the baby would be damaged during birth (OR 3.0; 1.7-5.5) and that the birth experience made them decide not to have any more children (OR 3.4; 1.1-10.7). Fathers reported a near-panic feeling when attending an instrumental vaginal birth (OR 5.2; 1.7-15.5). CONCLUSION: An instrumental vaginal birth was correlated with longer and more complicated births, epidurals and oxytocin augmentation. It affected the birth outcome and parents' feelings and was associated with future reproductive thoughts and a negative birth experience.

A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth.

OBJECTIVE: The aim of this study was to compare experiences and feelings during pregnancy and childbirth in women who preferred caesarean section during pregnancy and were delivered by a planned caesarean section, and women who preferred to give birth vaginally and actually had a spontaneous vaginal birth. DESIGN: Longitudinal cohort study where 693 women participated, 420 of whom were multiparas. METHODS: Data were collected from questionnaires distributed to women during pregnancy and two months postpartum in a Mid Sweden county. RESULTS: Women who preferred and actually were delivered by caesarean section experienced a fear of childbirth to a higher degree as compared to women with a vaginal birth. Despite a fulfilled request, women who had a caesarean section were not pleased with the decision making process. In addition, women who had a caesarean section on request were less satisfied with antenatal care and had a more negative birth experience, which made them doubt whether they would have more children. CONCLUSIONS: This study shows that a fulfilled request on mode of birth does not guarantee a positive birth experience. Antenatal information of all aspects of a caesarean section is vital for women who consider caesarean section where no medical indication is present. More research is needed about the decision making process regarding caesarean section on maternal request. Childbirth related fear is a common reason to request a caesarean birth. More knowledge about how women reason about caesarean section is required, and treatment related to fear of birth needs to be developed.

Women's experiences of induction of labour--findings from a Swedish regional study.

BACKGROUND: Induction of labour is common in modern obstetrics but its impact on women's birth experiences is inconclusive. AIM: The aim of the present study was to explore the prevalence of induction in a Swedish region and reasons for labour induction. A second aim was to compare the experience of spontaneous labour and birth for women to the experience of induction of labour. A third aim was to explore the difference in labour in relation to the length of pregnancy. METHODS: A one-year cohort of 936 women was included in a longitudinal Swedish survey in which data were collected by questionnaires, two months after birth. The main outcome was a set of data recording women's birth experiences. RESULTS: Labour induction was performed in 17% of births and mostly performed for medical reasons. Women who were induced used more epidurals (OR 2.3; 95% CI 1.4-3.8) for pain relief and used bath/shower less frequently for pain relief (OR 0.3; 95% CI 0.2-0.5). Labour induction was associated with a less positive birth experience (OR 1.5; 95% CI 1.0-2.3), and women who were induced were more likely to totally agree that they were frightened that the baby would be damaged during birth (OR 2.1; 95% CI 1.2-3.9), but the assessment of feelings during birth differed with regard to length of pregnancy. CONCLUSION: Labour induction affects women's experiences of birth and is related to length of pregnancy.

Behind the myth--few women prefer caesarean section in the absence of medical or obstetrical factors.

OBJECTIVE: to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference. DESIGN: mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis. SETTING: three hospitals in the county of Västernorrland in the middle of Sweden. PARTICIPANTS: 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy. FINDINGS: a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories. KEY CONCLUSIONS: rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way of giving birth is common during pregnancy. This should be of concern for midwives and obstetricians during antenatal care. Information and counselling should be frequent and comprehensive when a discussion on caesarean section is initiated by the pregnant woman. A negative birth experience is related to a future preference for caesarean section and this should be considered by caregivers providing intrapartum care.

Childbirth thoughts in mid-pregnancy: prevalence and associated factors in prospective parents.

BACKGROUND: Parents' thoughts about childbirth during pregnancy are important for the adjustment process but little is known about factors associated with such thoughts. OBJECTIVES: To describe and study background characteristics, feelings and support in relation to thoughts about childbirth in mid-pregnancy, in women and their partners and to analyze which factors are most important for having thoughts and feelings about childbirth. METHOD: A cross-sectional study of 1212 women and 1105 men recruited shortly after the routine ultra sound examination in pregnancy weeks 17-19. Data was collected by a questionnaire in mid-pregnancy. Data were analyzed using relative risks with 95% confidence interval and logistic regression. RESULTS: A high proportion of women (75%) and men (67%) reported having thoughts about childbirth. In women childbirth related fear Odds Ratio (OR) 2.7; [95% CI 1.62-4.37], high level of education (OR 1.8, [95% CI 1.32-2.34] and major emotional changes OR 1.5, [95% CI 1.0-2.1] were the most important factors associated with having thoughts about childbirth. In men, high level of education OR 1.1 [95% CI 1.41-2.52], getting the opportunity to ask question at prenatal visits OR 1.6 [95% CI 1.17-2.07], and expecting the first baby OR 1.6 [1.17-2.07] contributed most to the model. DISCUSSION: This study shows that the majority of prospective parents think about the birth of their baby in mid-pregnancy. Some factors are common for both parents, but women's thoughts are more based on emotional and physical changes and fears while men's are more based on the social situation such as expecting the first baby and organizational issues in prenatal care, and instrumental issues such as finances. Further studies are needed about the content of the parents' thoughts.

Women's postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section.

AIM: The aim was to evaluate a new anaesthetic routine and to study the effect of spinal opioids for caesarean section on postoperative pain, expectations of pain, satisfaction with pain treatment, breastfeeding, infant care and length of hospital stay. BACKGROUND: Inadequate postoperative pain relief is a problem among hospitalised patients. Women undergoing caesarean section have been shown to experience high levels of pain during the first days after operation. Women are expected to breastfeed and care for their newborn while recovering from major abdominal surgery and sufficient pain relief are of importance. DESIGN: Comparative patient survey. METHODS: Data were collected through a questionnaire distributed to two independent samples of women undergoing elective and emergency caesarean section before and after the introduction of an additive of opioids in obstetric spinal anaesthesia. Chi-square tests were performed, and risk ratios were used for bivariate analysis. Logistic regression modelling was used for multivariate analysis. RESULTS: The group of women undergoing caesarean section with opioids added to the spinal anaesthesia reported significantly lower levels of experienced pain. High pain levels irrespective of mode of caesarean section affected breastfeeding and infant care. Length of hospital stay for caesarean women was shortened and the consumption of analgesics was reduced. CONCLUSIONS: Women receiving an additive of opioids in spinal anaesthesia experienced lower levels of pain. Low pain levels facilitate breastfeeding and infant care and are of relevance for financial considerations. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicate that spinal opioids for women undergoing caesarean section have a positive effect on the postoperative pain experience. Women undergoing caesarean section and have high pain levels are in special need of attention and care because of a higher risk of a decreased ability to breastfeed and to take care of their newborn.

Cesarean section without medical reason, 1997 to 2006: a Swedish register study.

BACKGROUND: Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code. METHODS: Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data. RESULTS: The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p<0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables. CONCLUSIONS: The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.

Still behind the glass wall? Swedish fathers' satisfaction with postnatal care.

OBJECTIVE: To describe new fathers' satisfaction with postnatal care after the introduction of a more family-centered model and to study factors related to fathers' overall satisfaction with postnatal care. DESIGN: Two cohorts of fathers who had a live-born baby during a 15 weeks period in 2004 and 2006. SETTING: A Swedish hospital. Postnatal care options were traditional postnatal ward, early discharge, cocare at neonatal ward, and from 2006 a family suite on a hotel ward. SAMPLE: Two hundred and eighty-four fathers whose babies were born in 2004 and 356 fathers whose babies were born in 2006. METHODS: Data were collected using a questionnaire and descriptive statistical odds ratios with 95% confidence interval and logistic regression analyses were used. RESULTS: Six hundred and forty (64%) fathers completed the questionnaire. There was no improvement between the 2 years in satisfaction with the content of postnatal care, although fathers who stayed in the family suite on the hotel ward were more satisfied with the postnatal care over all. The following factors were most significant for predicting dissatisfaction with postnatal care: no support from staff, not being treated nicely, dissatisfaction with the environment, lack of medical check-ups for the mother, and visiting hours. CONCLUSION: A true family perspective should be applied in postnatal care and the new parents viewed as a family unit, not as medical cases only. Staff working in postnatal wards should be given the opportunity to involve fathers in postnatal care.

Swedish caregivers' attitudes towards caesarean section on maternal request.

BACKGROUND: Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians' and midwives' attitudes towards CS on maternal request. METHODS: A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated. RESULTS: The overarching theme was identified as "Caesarean section on maternal request-a balance between resistance and respect". On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.

Women's experiences of becoming a mother after prolonged labour.

AIM: This paper is a report of a study to explore women's experiences of becoming a mother after prolonged labour. BACKGROUND: The negativity associated with a complicated labour such as prolonged labour can lead to a struggle to become a healthy mother and could restrict the process of becoming a mother. METHODS: Interviews were conducted in 2004 with 10 mothers who had been through a prolonged labour with assisted vaginal or caesarean delivery 1-3 months previously. Thematic content analysis was used. FINDINGS: Three themes were formulated, describing women's experiences as fumbling in the dark, struggling for motherhood and achieving confidence in being a mother. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like 'fumbling in the dark'. Women experienced bodily fatigue, accompanied by feelings of illness and detachment from the child. Having the child when in this condition entailed a struggle to become a mother. In spite of these experiences and the desire to achieve confidence in being a mother, the reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged interaction and relationship with the child, and contributed to their adaptation to motherhood. CONCLUSION: Women experiencing prolonged labour may be comparable with the experience of and recovery from illness, which could contribute to difficulties transitioning to motherhood and limit a woman's ability to be emotionally available for the child.

Some Swedish women's experiences of prolonged labour.

OBJECTIVE: to elucidate women's experiences of prolonged labour. DESIGN: qualitative research interviews were conducted and thematic content analysis was applied. PARTICIPANTS: 10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery. FINDINGS: the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress. KEY CONCLUSIONS: the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself. IMPLICATIONS FOR PRACTICE: women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

Low psychosocial resources during early pregnancy are not associated with prolonged labour.

OBJECTIVES: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. STUDY DESIGN: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. RESULTS: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. CONCLUSIONS: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

The negative birth experience of prolonged labour: a case-referent study.

AIMS: This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. BACKGROUND: In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. METHOD: Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks' pregnancy at three hospitals in northern Sweden were recruited to a case-referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. RESULTS: Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, 'Pain relief during the delivery saved me' (OR 4.5, 95% CI: 1.9-11.1) and 'My difficulties during the delivery will mark me for life' (OR 12.4, 95% CI: 4.4-35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. RELEVANCE TO CLINICAL PRACTICE: To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.

Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach.

BACKGROUND: Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence-based knowledge for midwives. AIMS: This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth. DESIGN: A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH-terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non-randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three-grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III). RESULTS: Twenty-four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth. RELEVANCE TO CLINICAL PRACTICE: Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.