Epidural analgesia for labour and delivery: informed consent issues

Many anaesthetists believe that informed consent for epidural analgesia during labour is inadequate. Patients are perceived to be poorly informed and unable to cope with the information given during labour for informed consent. We reviewed these two hypotheses: A) to define complications for which patients want clear information: B) to quantify the influence of pain, anxiety, opioid premedication, and the importance of level of education, on a patient's level of satisfaction with regard to the consent process: and C) to assess how satisfactory epidural pain relief correlates with satisfaction with the consent process.

Sixty patients were surveyed during the first two months after vaginal delivery by two interviewers. Questions related to demographics, severity of labour pain, level of satisfaction with the epidural anaesthetic, risk of complications and satisfaction with information received were either categorical or scored on a scale from 0 to 10.

All epidural related complications were considered important to disclose (8.4/10). The level of satisfaction with the consent process was 8.1/10. Patient satisfaction was not affected by opioid premedication, anxiety, pain score, education group or level of pain relief.

Patients indicated they should be informed of all possible complications associated with epidural analgesia, regardless of severity or risk. In contrast to reports in the literature, non disclosure of serious risks during labour was not acceptable to parturients.