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. 2025 Nov 1;166(11):2668-2678.
doi: 10.1097/j.pain.0000000000003710. Epub 2025 Aug 29.

Frequency and risk factors for acute pain during vaginal birth with epidural analgesia: a nationwide population-based study from the 2021 French National Perinatal Survey

Clara Rollet  1   2 , Marie-Pierre Bonnet  1   3 , Marie Viaud  1 , Nathalie Lelong  1 , Camille Le Ray  1   2 , Anne Alice Chantry  1   4 ; ENP2021 Study Group
Collaborators, Affiliations

Frequency and risk factors for acute pain during vaginal birth with epidural analgesia: a nationwide population-based study from the 2021 French National Perinatal Survey

Clara Rollet et al. Pain. .

Abstract

Epidural analgesia is the gold standard for labor pain relief, but severe pain during childbirth can still occur. We assessed frequency and risk factors for acute pain at vaginal birth among women using epidural analgesia. Data were from the 2021 French National Perinatal Survey, a cross-sectional, nationwide, population-based study. Women who delivered vaginally with epidural analgesia were included. Pain at the time of birth was assessed using a numerical pain rating scale and categorized as (no/mild [0-3], moderate [4-6], or severe pain [7-10]). Determinants of moderate and severe pain were identified using multinomial multilevel logistic regression. Among 7211 women, 16.9% experienced moderate pain and 31.4% severe pain at birth. Risk factors for severe pain included maternal age <25 years (adjusted odds ratio 1.39; 95% confidence interval [1.14-1.70]), overweight (1.40 [1.20-1.63]), obesity (1.44 [1.19-1.73]), pushing effort >30 minutes (1.94 [1.60-2.36]), epidural-to-birth interval <1 hour (3.49 [2.50-4.87]) or ≥10 hours (1.68 [1.38-2.05]), self-reported partially effective (4.73 [4.07-5.49]) or ineffective (21.3 [14.3-31.8]), epidural analgesia and anesthesiologist not dedicated to maternity care (1.33 [1.11-1.58]). Protective factors included maternal age ≥35 years (0.82 [0.69-0.96]), high education (0.81 [0.68-0.96]), and patient-controlled epidural analgesia [PCEA] (0.70 [0.60-0.83]). The combined spinal epidural technique (CSE) was protective among women with effective epidural and exposed for at least 1 hour (0.22 [0.05-0.98]). One in 3 women who delivered vaginally reported severe pain at birth despite epidural analgesia. Expanding the use of PCEA and CSE technique could improve pain management. Increased vigilance is needed for young, overweight/obese women, and those with short or prolonged epidural-to-birth intervals.

Keywords: Birth; Epidural analgesia; Labor; Pain; Vaginal birth.

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References

    1. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 209: obstetric analgesia and anesthesia. Obstet Gynecol 2019;133:e208–25.
    1. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018;5:CD000331.
    1. Bauer ME, Kountanis JA, Tsen LC, Greenfield ML, Mhyre JM. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. Int J Obstet Anesth 2012;21:294–309.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Stat Methodol 1995;57:289–300.
    1. Bonnet M-P, Prunet C, Baillard C, Kpéa L, Blondel B, Le Ray C. Anesthetic and obstetrical factors associated with the effectiveness of epidural analgesia for labor pain relief: an observational population-based study. Reg Anesth Pain Med 2017;42:109–16.

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