A Snapshot of Women’s Attitudes and Preferences Toward Labor Epidural Analgesia and Cesarean Delivery

Purpose: Popular media and health services data suggest a shift in pregnant women’s attitudes toward increasing acceptance of labor epidural analgesia (LEA) and primary elective cesarean delivery (CD) in North America. We sought to provide a snapshot of women’s attitudes towards these interventions within our institution. Methods: Following REB approval and consent, women were recruited in three groups to participate in a mixed methods survey examining attitudes/preferences for LEA and delivery mode. Groups were: (1) young non-pregnant women (18- 25 years) from a university campus, (2) pregnant women attending antenatal clinic at Sunnybrook Health Sciences Centre (SHSC), and (3) older (>50 years), non-pregnant women providing non-professional labor support at SHSC. Results: 281 women participated. Thirty-two percent (38/120) of Group 1, 52% (54/103) of Group 2, and 64% (36/56) of Group 3 indicated that they would choose LEA for pain avoidance, to enjoy childbirth, conserve energy, and “no good reason not to”. Conversely, 7.5% (9/120) of Group 1, 16% (16/103) of Group 2 and 16% (9/56) of Group 3 indicated that they would not want LEA for fear of risks and resistance to medical interventions. Notably, 6% (7/119) of Group 1, 10% (10/104) of Group 2 and 13% (7/56) of Group 3 indicated a preference for CD to avoid labor pain and perineal injury, maintain control and for perceived safety. Conclusions: Rising LEA and cesarean rates may reflect their increasing acceptance by women regardless of age and pregnancy status. Further work is required to explore our findings across a larger number of settings.