1. Objectifs

Intentions :
«This study aimed to explore barriers and facilitators to birth without epidural in a tertiary center, from the perspectives of nurses, doctors, and patients who planned to give birth without epidural.» (p. 296)

Questions/Hypothèses :
«The main research questions were: […] What are the barriers to birth without epidural? […] What are the facilitators to birth without epidural? […] What changes would need to be made to enhance support for birth without epidural?» (p. 296)

2. Méthode

Échantillon/Matériau :
L’échantillon est composé de 4 mères et de 10 professionnels de la santé. «The study site was an urban tertiary-quaternary university hospital in Quebec, Canada, which is staffed by perinatal nurses, obstetricians (including perinatologists), and anesthesiologists.» (p. 296)

Instruments :
Guide d’entretien semi-directif

Type de traitement des données :
Analyse de contenu

3. Résumé

This article shows that «[e]pidural rates in tertiary settings are influenced by contextual factors. [The authors] identified more barriers than facilitators to supporting birth without epidural.» (p. 300) In this study, all «patients expressed personal motivations to avoid epidural, describing factors like previous birth experiences, beliefs about medications, and social or cultural beliefs about birth.» (p. 299) The analysis demonstrates that «[p]atients want to be involved in decision- making during labor and birth. Feeling in control has a positive impact on postnatal satisfaction with birth experiences; specifically, managing pain as planned before going into labor is associated with postnatal satisfaction. How patient and health care professional goals and priorities diverge or align may facilitate or hinder birth without epidural, and therefore have an important impact on patient satisfaction.» (p. 300) Moreover, «[h]ealth care professionals said patient preparation, including prenatal courses and pain management knowledge, was essential to birth without epidural.» (p. 298) «Several health care professionals highlighted the importance of being “mentally” prepared for pain, and patients described cognitive coping strategies. Health care professionals expected support during labor to be provided by family members or a doula […].» (p. 299)