[[alternative]]Relationship of Epidural Analgesia and Maternal-Infant Birth Outcomes and Sucking Behaviors

[[abstract]]背景：分娩是婦女生命中極為深刻且影響深遠的經驗，緩解生產疼痛對婦女而言極為重要。根據統計台灣約有30%的婦女於待產時選擇硬膜外麻醉減痛，而硬膜外麻醉減痛對產婦本身與胎兒造成生理的影響，是產婦與醫護人員關心的重要議題。目的：硬脊膜外麻醉與母嬰生產結果及吸吮行為之相關性。研究設計：採病例對照法，以病歷回溯方式收集受試者資料，資料來源為南部某醫學中心婦產科，探討硬膜外麻醉與母嬰生產結果及吸吮行為的影響。共收案636人，分為兩組，採用硬膜外麻醉減痛產婦為個案組（n=336），無使用硬膜外麻醉減痛者為對照組（n=320）。研究變項產程時間、生產方式及新生兒吸吮行為。所收集資料將以SPSS20.0統計軟體分析，含t檢定、卡方檢定、二元邏輯斯迴歸分析及線性迴歸分析等。結果：單變項分析結果顯示硬膜外麻醉組與對照組在第一及第二產程時間、生產方式及待產及產後單次導尿次數達顯著差異。線性迴歸分析結果顯示使用硬膜外麻醉第一產程時間及第二產程時間較長，達統計上顯著差異（p < .05）。以二元邏輯斯迴歸分析後，個案組相對於對照組其真空吸引生產的機率為2.398倍（OR=2.398，95% CI=1.602-3.590，p<.001），達統計上顯著差異。個案組待產時執行導尿（單次或留置）為對照組6.627倍（OR=6.627，95% CI=3.824-11.483，p< .005）。吸吮行為兩組無顯著差異。結論及臨床應用：硬膜外麻醉減痛使用真空吸引生產及第一、二產程延長、待產及產後導尿的風險明顯增加。建議護產人員應教導懷孕待產婦女及其家人有關硬膜外麻醉減痛可能產生之副作用及風險，並教導他們如何以非藥物方式緩解生產疼痛。[[abstract]]BackgroundMany mothers identify labor pain as the most excruciatingly painful experience of their lives. In Taiwan, epidural anesthesia is administered in approximately 30% of deliveries in order to reduce labor-related pain. This technique involves the injection of a local anesthetic into the lower region of the spine in order to block the transmission of pain stimuli from the contracting uterus and dilating birth canal to the central nervous system. The effectiveness and the immediate and long-term effects of epidural anesthesia largely determine the intrapartum satisfaction rates of delivering mothers. However, limited research has examined the important issue of the impact of epidural anesthesia on the maternal and fetal physiology. Thus, the present study examines the relationship between epidural anesthesia and maternal-fetal birth outcomes. ObjectiveTo examine the relationship between the use of epidural anesthesia and maternal-infant birth outcomes and infant sucking behaviors.Design, setting, and participants: A case-controlled, single-centered study was used. Data were collected retrospectively using chart reviews for the period 2013-2015 from the obstetrics and gynecology department of a medical center in southern Taiwan. A total of 636 pregnant women who had given birth at the targeted medical center were included as participants, with the 336 who had received epidural anesthesia allocated to the study group and the 320 who had not received epidural anesthesia allocated to the control group. The study variables included: length of labor, mode of delivery, degree of laceration, urinary catheterization, and neonate sucking behavior. Data were analyzed with SPSS 20.0 software using the student t-test, chi-square test, binary logistic regression, and linear regression analysis. Statistical significance was recognized when p<.05.Results:After controlling for demographic variables, the present study found associations between epidural anesthesia and longer first and second stages of labor, increased incidence of instrument-assisted delivery, and increased risks of intrapartum and postpartum urine catheterization. Logistic regression analysis revealed that vacuum extraction delivery was used 2.398 times more by the study group than the control group (OR = 2.398, 95% CI = 1.602-3.590, p <.001) and that the rate of intrapartum urine catheterization (single use or foley catheter indwelling) was 6.627 times higher in the study group than in the control group (OR = 6.627, 95% CI = 3.824-11.483, p <.005).Conclusions and clinical applications: The present study found that epidural anesthesia was associated with higher rates of vacuum extraction delivery, longer first and second stages of labor, and increased risks of intrapartum and postpartum urine catheterization. Healthcare providers should inform expectant mothers and their families regarding these side effects and risks of epidural anesthesia prior to using this technique. Non-invasive and non-pharmacological methods of pain relief that present lower levels of risk should be offered