Not only availability but a wide range of patient and caregiver preferences will influence the decision to use epidural analgesia to relieve labor pain. To learn how prelabor maternal attitudes influence this practice, 303 nulliparous women having either spontaneous or induced labor at term were given a questionnaire while attending childbirth classes dealing with their preferences for receiving intrapartum epidural analgesia. All participants had singleton term pregnancies with a cephalic presentation. The study group comprised mostly white women with an average age of 31 years and who were highly educated. More than 80 percent had private insurance, and a similar proportion had an obstetrician as their primary caregiver.All but 10 percent of the women viewed pain as a natural part of childbirth but nevertheless thought that epidural analgesia should be available if needed. One fourth definitely planned to have an epidural, and another 36 percent thought it likely. Only 7 percent disavowed any intention of getting an epidural, although 29 percent of the group wished to avoid it (3 percent expressed no preference). The overall epidural rate was 78 percent. Of those women who did receive an epidural, 71 percent had indicated that they would definitely or probably request one. About 60 percent of women who tried to avoid an epidural ultimately asked for one, as did 43 percent of those who definitely intended not to have an epidural. Women who planned to receive an epidural tended to receive one earlier than the others, at 3 cm or less of cervical dilation.In this group of nulliparous women, a prenatal intention to receive epidural analgesia strongly predicted that one would be given. The findings emphasize the importance of ensuring that women know of the risks and benefits of epidural use so that their decision will be an informed one. Epidurals have been associated with longer labors, more operative deliveries, and a higher risk of intrapartum fever.Birth 1999;26colon;139ndash;143
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