[Ambulatory obstetric epidural analgesia: Maternal satisfaction and obstetrical safety - Cohort study]

In obstetrics, walking or ambulatory epidural analgesia (APDD) represents an evolution of non-ambulatory epidural analgesia (APD), allowing women to maintain mobility during labor. In a context of increasing demand for more physiological childbirth, it is important to assess its impact on maternal satisfaction and obstetric safety. This article aims to compare maternal satisfaction and obstetric outcomes between women who received APDD and those who received non-ambulatory APD.

We conducted an ambispective cross-sectional cohort study in a tertiary maternity unit between June and November 2024. Women who delivered vaginally with either APDD or non-ambulatory APD were invited to complete the French Questionnaire d'Évaluation du Vécu de l'Accouchement (QEVA), supplemented by six items specifically addressing pain management. Obstetric and neonatal outcomes were collected from medical records.

A total of 217 women were included (48 in the APDD group and 169 in the APD group). APDD was associated with lower maternal dissatisfaction: no women reported feeling "not at all active" or "not at all autonomous" during childbirth, nor that they would not recommend the technique, whereas dissatisfaction rates reached up to 5.9% in the APD group. The overall QEVA score did not significantly differ between groups (60.9±5.3 vs. 60.2±6.1; P=0.44). Among extreme responses (value=1), only the frequency of "unusual sensations" differed significantly (4.2 vs. 18.9%; P=0.012). Obstetric and neonatal outcomes (cesarean rate, instrumental delivery, postpartum hemorrhage, neonatal complications) were comparable between groups.

APDD appears to be a safe technique that improves maternal satisfaction without compromising obstetric or neonatal outcomes. Its broader implementation, supported by national guidelines, could better meet women's growing expectations for a more physiological childbirth.