| Objectives:1. To investigate and compare the awareness and attitude of pregnant women attending antenatal clinic towards epidural analgesia (EA) between two neighboring countries with a different socio-economic and cultural background.2. To assess contributing factors which influence the understanding level of EA among pregnant women and options of pain relief services used in labor.Methods:This was a questionnaire-based descriptive study of pregnant women conducted between antenatal clinics of Zhongda Hospital, Nanjing, China and Paropakar's Maternity Hospital, Kathmandu, Nepal; with the survey period being from June 2015 to October 2015. A total of 1000 women; 500 from China and 500 from Nepal were randomly selected and a total of 155 husbands of CW who had accompanied their wives during the antenatal checkup were also separately interviewed. Information was obtained by use of questionnaires through one-on-one interviews. Our questionnaire consisted of 5 sections; Section A:socio-demographic characteristics, Section B:awareness and attitudes towards labor pain, Section C:women's awareness and attitudes towards EA, Section D:characteristics of past obstetrical experiences, and Section E:Chinese husbands'knowledge regarding EA. For the Statistical analysis; EPIDATA 3.1 and Statistical Package for Social Scientists (SPSS) 19.0 were used. Continuous parameters were calculated as mean, Standard Deviation and also Student's t-test was used to determine the statistical significance of differences. Descriptive statistics, namely frequencies and percentages were calculated. Chi-square test was used to assess the statistical significance of the association between them. P value<0.05 was considered to be statistically significant.Results:1. Information regarding socio-demographic characteristics in two hospitals (China/Nepal) showed that mean maternal age was 28.9±3.9/27.5±4.4 years (p<0.001), mean gestational age (29.2±7.9)/(28.9±8.4) weeks (p>0.05); and mean values of total antenatal check up done in'municipal level hospital & above'and'district level hospitals & below'were (4.8±3.4)/(1.6±4.8) and (4.3±2.6)/(0.05±0.3) times respectively (p<0.001). Most of them were primiparas:418 (83.6%)/388(77.6%) (p<0.05), monthly family income: 424(84.8%) of Chinese women (CW) was above 3000 Ren Min Bi (RMB) and 411(82.2%) of Nepalese women (NW) was above Nepalese Rupees (NRs.) 25000 (p>0.05), and an equal proportion of 488(97.6%) had single baby in current pregnancy in both countries (p>0.05).2. The Women's attitude towards labor pain was documented. The majority of 314 (62.8%) of Chinese participants believed that they could calmly face the pain of labor for their upcoming labor. In contrast,444(88.8%) of NW felt nervous and scared about it. An almost similar proportion of 118(23.6%) Chinese and 104(20.8%) Nepalese expressed their willingness to choose Cesarean Section (CS) to avoid painful labor (p>0.05).3. Regarding awareness and attitude towards EA:the total number of participants who had heard about Labor analgesia (LA) was 451(90.2%)/158(31.6%), of these 281(62.3%) of Chinese were familiar with EA, among the types of analgesia known; but only 39(24.7%) Nepalese had knowledge regarding EA (p<0.001). Majority of both groups,334(66.8%)/ 396(79.2%) had no idea whether their hospital provided obstetrics EA or not (p<0.001). Only a small proportion of both 108(21.6%) of CW and 81(16.2%) of NW reported of having been introduced to EA in this pregnancy (p<0.05). Of these, the major source of information regarding EA was obtained from friends/relatives and media/books in both groups. Compared to the Nepalese group, there was a significantly higher proportion of CW who had been discussed by caregiver towards types of LA:29.6%/1.2%(P<0.001). Regarding attitude towards EA, the majority of pregnant women (China:90.0%, Nepal: 94.4%) and their health caregivers (China:87.0%, Nepal:93.9%) had opted for neutrality (among the category:positive, neutral and negative, P<0.001). On the other hand, a similar proportion of 174(34.8%) CW and 152(30.4%) NW expressed that they would be willing to have EA for upcoming delivery. Whilst, only 59(11.8%) CW and 132(26.4%) NW were unwilling for EA (p<0.001). The commonest reason was fear of having adverse effects on mother or infant.4. For the past obstetrical history:a total of 23(28.0%)/36(32.1%) women had previously chosen elective Cesarean Section (ELCS) as their mode of delivery (p=0.002), among them, all 23(100%) of Chinese women stated the cause being other than the fear of labor pain, but in contrast 22(61.1%) of Nepalese women had fear of labor pain which was the reason for choosing ELCS (p<0.001).37(45.2%) of Chinese women reported the degree of labor pain as severe while 69(61.6%) of Nepalese women felt moderate level of pain (p<0.001). Only 10(12.2%) of Chinese women have had an experience of labor analgesia, among them 3(30.0%) had received EA. Whereas for all Nepalese women 112(100%) reported having no experience of labor analgesia in their past delivery (p<0.001).5. The Chinese husbands'attitude and awareness towards EA show that about 125(80.7%) had heard about labor analgesia and 108(81.2%) were familiar with EA as being the most common type of LA.147 (94.9%) had expressed neutral attitudes towards EA. An equal proportion,19(12.3%) each showed willingness and unwillingness towards EA for upcoming delivery. The commonest reason for unwillingness was fear of adverse effect on mother's and baby's health.Conclusions:1. This was a comparative analytical study of pregnant women between two hospitals of China and Nepal. The descriptive study primarily showed that women's awareness and attitude toward EA was significantly higher in CW as compared to that of NW.2. This study showed that there is insufficient awareness about the availability of EA services in the hospitals of both countries. Also, they are not receiving this information from the proper channel during their antenatal visits. So this survey reflects the wide gap in the communication between pregnant women and obstetricians.3. Improving the understanding level of EA among pregnant women may prevent women from making the difficult choice of cesarean section due to fear of painful labor.4. Though the majority of Chinese husbands have heard about LA, however, there is poor general awareness about the proper role of EA.5. This study strongly suggests providing standardized EA education to caregivers and proper sharing of information with pregnant women at an appropriate time may benefits the use of EA. |
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