Partner's presence during initiation of epidural labor analgesia does not decrease maternal stress

A prospective randomized controlled trial

Sharon Orbach-Zinger, Yehuda Ginosar, Julia Sverdlik, Claudio Treitel, Kiri S. Mackersey, Ron Bardin, Dan Peleg, Leonid A. Eidelman

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain. METHODS: Healthy, nulliparous women who were accompanied by their partners and requested neuraxial analgesia were enrolled into the study. The study took place in the Labor and Delivery Unit of a large tertiary hospital in Israel. Upon request for epidural analgesia, both partners were assessed for baseline anxiety (numerical rating scale, 0 to 10), systolic blood pressure, heart rate, estimated contraction pain of parturient (verbal rating scale for pain, 0 to 10), and salivary amylase. After measurements, couples were randomized into 1 of 2 groups: "partner in" and "partner out." Immediately after epidural catheter insertion, anxiety, arterial blood pressure, heart rate, and salivary amylase were measured again in both partners. Both partners were asked to complete the State Anxiety Inventory questionnaire measuring current anxiety. The parturient was asked to rate the pain of epidural catheter insertion. The primary outcome measurement was parturient and partner anxiety as assessed by the numerical rating scale. RESULTS: Eighty-four couples were randomized (partner in 41, partner out 42, protocol violation 1). At baseline there was no difference in self-reported anxiety of parturients between the partner-in and partner-out groups (median interquartile range 7.5 [6.0 to 9.0] versus 7.0 [3.5 to 8.5]; P = 0.26, difference in medians = -1.0; 95% confidence interval [CI] of difference -2.0 to 1.0). After epidural catheter insertion, parturients in the partner-in group had a higher level of anxiety than those in the partner-out group (8.0 [7.0 to 10.0] versus 7.0 [5.0 to 9.0]; P = 0.03, difference in medians -1.0; 95% CI of difference -2.0 to 0.0). Pain scores during epidural catheter placement were higher in partner-in than in partner-out groups (7.0 [4.0 to 8.0] versus 4.0 [3.0 to 6.0]; P = 0.004, difference in medians = -2.0; 95% CI of difference -3.0 to -1.0). CONCLUSION: Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.

Original languageEnglish (US)
Pages (from-to)654-660
Number of pages7
JournalAnesthesia and Analgesia
Volume114
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

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Epidural Analgesia
Anxiety
Randomized Controlled Trials
Mothers
Catheters
Parturition
Pain
Confidence Intervals
Amylases
Analgesia
Heart Rate
Blood Pressure
Pain Perception
Israel
Tertiary Care Centers
Arterial Pressure
Equipment and Supplies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Partner's presence during initiation of epidural labor analgesia does not decrease maternal stress : A prospective randomized controlled trial. / Orbach-Zinger, Sharon; Ginosar, Yehuda; Sverdlik, Julia; Treitel, Claudio; Mackersey, Kiri S.; Bardin, Ron; Peleg, Dan; Eidelman, Leonid A.

In: Anesthesia and Analgesia, Vol. 114, No. 3, 03.2012, p. 654-660.

Research output: Contribution to journalArticle

Orbach-Zinger, Sharon ; Ginosar, Yehuda ; Sverdlik, Julia ; Treitel, Claudio ; Mackersey, Kiri S. ; Bardin, Ron ; Peleg, Dan ; Eidelman, Leonid A. / Partner's presence during initiation of epidural labor analgesia does not decrease maternal stress : A prospective randomized controlled trial. In: Anesthesia and Analgesia. 2012 ; Vol. 114, No. 3. pp. 654-660.
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AU - Treitel, Claudio

AU - Mackersey, Kiri S.

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N2 - BACKGROUND: Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain. METHODS: Healthy, nulliparous women who were accompanied by their partners and requested neuraxial analgesia were enrolled into the study. The study took place in the Labor and Delivery Unit of a large tertiary hospital in Israel. Upon request for epidural analgesia, both partners were assessed for baseline anxiety (numerical rating scale, 0 to 10), systolic blood pressure, heart rate, estimated contraction pain of parturient (verbal rating scale for pain, 0 to 10), and salivary amylase. After measurements, couples were randomized into 1 of 2 groups: "partner in" and "partner out." Immediately after epidural catheter insertion, anxiety, arterial blood pressure, heart rate, and salivary amylase were measured again in both partners. Both partners were asked to complete the State Anxiety Inventory questionnaire measuring current anxiety. The parturient was asked to rate the pain of epidural catheter insertion. The primary outcome measurement was parturient and partner anxiety as assessed by the numerical rating scale. RESULTS: Eighty-four couples were randomized (partner in 41, partner out 42, protocol violation 1). At baseline there was no difference in self-reported anxiety of parturients between the partner-in and partner-out groups (median interquartile range 7.5 [6.0 to 9.0] versus 7.0 [3.5 to 8.5]; P = 0.26, difference in medians = -1.0; 95% confidence interval [CI] of difference -2.0 to 1.0). After epidural catheter insertion, parturients in the partner-in group had a higher level of anxiety than those in the partner-out group (8.0 [7.0 to 10.0] versus 7.0 [5.0 to 9.0]; P = 0.03, difference in medians -1.0; 95% CI of difference -2.0 to 0.0). Pain scores during epidural catheter placement were higher in partner-in than in partner-out groups (7.0 [4.0 to 8.0] versus 4.0 [3.0 to 6.0]; P = 0.004, difference in medians = -2.0; 95% CI of difference -3.0 to -1.0). CONCLUSION: Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.

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