Variations between midwives regarding administration of obstetrical analgesia

Variations among 32 midwives involved in a total of 1578 deliveries were studied regarding attitudes to and use of obstetrical analgesia. Relevant data were obtained from the register of the maternity department of a Swedish regional hospital. This was complemented with information about the midwives' attitudes to pharmacological pain relief in labour and delivery, collected by means of a mailed questionnaire. Variations between midwives (range), expressed as percentages of each midwife's total number of deliveries, were considerable: epidural block (EDA), 9-48%; Pethidine, 0-41%; Entonox (N2O/O2), 8-62%; pudendal block (PDB), 11-71%. Midwives working on night-shift used less EDA, but more pethidine, than their day-shift colleagues. 59% of all the midwives were critical of current levels of obstetrical use of analgesics in Sweden, while 41% felt the level to be about right. Night-shift midwives were rather more critical than day-shift midwives. Midwives critical of current levels of obstetric medication used EDA and PDB less often than their more enthusiastic colleagues, but the difference was not statistically significant. On the other hand, critical midwives used more Pethidine (p less than 0.05) and also more Entonox than their less critical colleagues, though again the difference was statistically non-significant.