Finding a Way to Relieve Delivery Pain
That is Right for You

Helping pregnant women make an informed decision about
epidural anesthesia and no epidural anesthesia

There are several ways to relieve labor pain, each with its own
advantages and disadvantages.
This Aid is intended to help pregnant women planning on vaginal
delivery to make an informed decision about whether to give birthby epidural anesthesia or no epidural anesthesia.

Contents
STEP 1: Learning how to make an informed
decision････････････････････････････････････････････････1

STEP 2: Learning the pros and cons of each
option･･･････････････････････････････････････････････････4

STEP 3: Setting clear priorities for decisionmaking ･････････････････････････････････････････････････21

STEP 4: Making your decision･･････････････････････ 23

Anesthesia used during childbirth can be achieved by using
several methods, which may include the use of epidural
anesthesia, spinal anesthesia, or both. Epidural anesthesia is a
popular choice in Japan.

STEP１

Learning how to make an informed decision● How is this Aid used for making an informed decision?
There are options for vaginal delivery, each with its own
advantages and disadvantages.
This Aid is intended to help pregnant women planning on vaginal
delivery to make an informed decision about whether to give birth byepidural anesthesia or no epidural anesthesia.
This Aid consists of the following steps.
When reading this Aid for the first time, please read the steps inorder.

STEP１

Learning how to make an informed decision

P1 – P3

STEP２

Learning the pros and cons of each option

P4 – P20

STEP３

Setting clear priorities for decision-making

P21 - P22

STEP４

Making your decision

P23 - P25

1

STEP１

Learning how to make an informed decision● How to use this Aid for making an informed decision
Let’s find out if this Aid is helpful for you.
This Aid is not intended to promote one option over another. This
Aid was created for the purpose of helping you to choose the methodof relieving labor pain that is right for you. Reading the contents of thisAid will help you to gain a more correct understanding and think about
your priorities for making a decision, thereby facilitating communication
with doctors, midwives, family, colleagues and friends, and women who
have already experienced childbirth.
This Aid was created for the following women.
Who this Aid is for Women planning on having a vaginal delivery
 Women not sure about epidural anesthesia

This Aid is not for women with the following conditions
Women requiring in-person consultation with a doctor

Women who have been recommended to have a
Caesarean section by doctors



Women who have been recommended to have an
epidural anesthesia by doctors (those with heart disease,pregnancy-induced hypertension, etc.)* An “Aid” is a tool related to decision-making that can be used incases where there are multiple options for treatments or examination,
each with their own advantages and disadvantages.

2

STEP１

Learning how to make an informed decision

Let’s find out how you want to be involved in choosing a childbirthdelivery method.
What is most important is “how you go about making a decision”.
There are 3 approaches you can take when making a decision.
Let’s find out which approach you want to take in making yourdecision.

a) Like to make my own decisions based on sufficient information.
b) Like to make decisions together with health professionals andmy family”.
c) Like to “have someone else, such as a doctor, a midwife, or afamily member, make decisions for me”.

This Aid will be helpful to those who choose a) and/or b) above. Please
continue onto the next page.

If you wish to have someone such as a doctor, a midwife, or a family
member make decisions for you, as in option c), you may findinformation in this Aid less useful.

If you choose c), you can still use this Aid by reading it together withyour family to check if the method chosen by your doctor is right for you.

3

Learning the pros and cons of each option(basic knowledge of vaginal delivery)

STEP２● General process of vaginal delivery
This Aid is particularly focused on making the decision between“epidural anesthesia” and “no epidural anesthesia” in the generalprocess of vaginal delivery.

Baby is positioned head-down.
No experience with Caesarean section or uterus surgery.
Not having placenta previa, etc.

Suitable for vaginal delivery

Painless delivery

Natural delivery

During vaginal delivery, when labor starts, the uterus receivescommands from the brain that causes periodic tightening and relaxingof the uterine muscles, thereby opening the cervix to push the baby
downward through the birth canal.
This process is common both in epidural anesthesia and no
epidural anesthesia.
・How do you manage pain during natural delivery?
Natural delivery is a spontaneous delivery method without theuse of anesthetics during delivery. Methods of relieving labor pain
include applying a hot pack or ice-pillow to the back, applying pressurearound the back and anus, and rubbing or patting. These methods are
considered effective in relieving labor pain by gently acting on the neuralcircuits for pain.

4

・How do you manage pain during epidural anesthesia?
Epidural anesthesia is a method of relieving labor pain that
requires the insertion of a thin tube called a catheter into the epiduralspace near the spinal cord of the back and injecting local anesthetics
upon request by the pregnant women who is experiencing increasing
labor pain. Injected medicines act on nerves around the epidural spaceand prevent pain by blocking the nerves that transmit pain from theuterus, the vagina, the vulva, and the perineum.

5

STEP２

Learning the pros and cons of each option(basic knowledge of vaginal delivery)● What is labor?
 The smooth delivery of a baby requires uterine contraction to push
the baby out. This uterine contraction is also known as labor.
 Labor causes the cervix to gradually dilate, which helps the baby togradually descend into the canal. Labor pain occurs regularly andbecomes gradually stronger. When the cervix is fully dilated, the baby
can pass through the cervix and move into the birth canal.
 Although there is variation in the periods and durations of labor
among individuals, it is generally known that it takes first-time women
between 11 and 15 hours on average, and women who have alreadygiven birth between 6 and 8 hours on average, to give birth after
experiencing regular labor.

● Steps and progression of childbirthThe longest period is when the cervix is dilating to the maximum level
after labor starts. It is generally known that this step takes first-time
women between 10 and 12 hours, and women who have alreadygiven birth between 5 and 6 hours.

As the childbirth progresses, each contraction becomes longer andmore intense, and the intervals between contractions become
shorter.



When the cervix is dilated to the maximum level, the intervals
between contractions become even shorter. It is known that it takes
first-time women between 1 and 2 hours, and women who havealready given birth between 30 minutes and 1 hour, to give a birth
after the cervix is dilated to the maximum level.

While the uterus contracts, the midwife tells the mother to “push”
and the mother pushes to bring the baby out on that cue. The
contractions and pushing force cause the baby to gradually descend
through the birth canal.

When the baby’s head is almost out, the mother stops pushing andstarts taking quick shallow breaths. After a short period, the baby is
born.



Mild contractions begin 5 to 20 minutes after the baby is born, andthe placenta is delivered to complete childbirth.

6

STEP２

Learning the pros and cons of each option(basic knowledge of painless delivery)● Timing for starting painless delivery

Epidural anesthesia is started when labor pains become stronger
and pregnant women wish to alleviate the pain.
Epidural anesthesia is usually started when the contractions takeplace 5 minutes apart and the cervix is dilated to a width ofapproximately 3 to 5 cm.

● Steps of painless deliver treatmenta) The pregnant woman lies on her side or takes a sitting position, andarches her back on a delivery bed.
b) A disinfectant is applied to the back and local anesthesia is inducedin the part of the body where the needle is inserted. This operation
causes a brief pricking sensation like getting an injection.
c) A thick needle (epidural needle) for placing a tube is inserted. This
operation causes a pressure sensation but almost no pain due toeffects of the local anesthesia.
d) When the needle tip reaches the epidural space, a thin tube (catheter),which is inserted through the needle, is threaded through into theepidural space. The needle is then removed so that only the catheter
stays in the epidural space.
e) Anesthetics are injected through the catheter.
f) It takes approximately 20 to 30 minutes to relieve labor pain after the
epidural injection.
g) After the catheter is inserted, a certain amount of anesthetic iscontinuously injected using an injection pump.

7 Epidural anesthesia relieves labor pain by numbing bodyparts below the belly button without making you sleep, thus
allowing you to be fully conscious during childbirth.
 When pain before starting anesthesia is rated as 10/10,
labor pain is reduced to approximately 1 to 3. You may feelsome tightness in your stomach, but this varies fromindividual to individual.
 Using low doses of anesthetic does not make you feelcompletely numb. You may still feel the pressure ofcontractions around the buttocks as childbirth progresses.

8

STEP２

Learning the pros and cons of each option● How are delivery methods chosen by women who
have already given birth?
< No epidural anesthesia >Reasons for choosing no epidural anesthesia
Preferring naturaldelivery
自然が良いと思うから

58.4%

Being confident with natural
乗り越えられると思うから
delivery46.6%

To experience labor pains at
1回は陣痛を体験しようと思うから
least once

41.6%

Othersその他

18.9%

Previous satisfying childbirth
前回の出産体験が良かったから
experience9.2%

To avoid medical
intervention
医療介入が嫌だから

7.1%

0%

10%

20%

"Other" reasons・High costs of painless delivery
・Short delivery time inprevious experience

30%

40%

50%

60%

70%

<Painless delivery>
Reasons for choosing epidural anesthesia
体力を温存したいから
Preservation of physicalstrength73.8%

To 痛みが嫌だから
avoid pains
Being afraid of pain,
sensitive
to pains, or not
痛みが怖い、痛みに弱い、…
confident in bearing pain
Delayed child-bearing
高齢妊婦だから

57.9%
47.3%
41.3%

Recommended by friends or
友人・知人に勧められたから
colleagues

22.5%

Previous tough
前回の出産がつらかったから
childbirthexperience

19.2%

Othersその他

6.6%

Recommended
by family
家族に勧められたから

5.9%

Recommended
by doctors
医師に勧められたから
0%"Other" reasons・Previous painless delivery experience
・Being told quicker recovery fromchildbirth

0.7%
20%

40%

60%

80%

Data were obtained from patients at the National Center for Child Health and Development from2016 to 2017.
Reference： Shishido E. & Horiuchi S. Hope of delivery using epidural anesthesia during laborcompared with no anesthesia and delivery outcomes (2018). Japanese Journal of Maternal Health59(1), 112-120.

9

STEP２

Learning the pros and cons of each option● Comparison of advantages and disadvantages between
epidural anesthesia and no epidural anesthesia
Comparison of advantages and disadvantages in both methods.
Let us compare the advantages and disadvantages of each
optionPointsNo epidural anesthesia

Labor painrelieving effects

Limited effects

What to expect
during delivery

Analgesic sideeffects

Epidural anesthesia
Highly effective

・You have to remain on a・You will be able to walk arounddelivery bed.
freely.
・ Eating and drinking are
・ You will be able to eat andrestricted.
drink freely.
・ You cannot go to the・You will be able to go to thebathroom and will need tobathroom.
urinate through a tube
(catheter).
localanesthetic,intoxication
anaphylactic shock, postdual――――――
puncture headache,
low blood pressure, fever,itchy skin, etc.

Impact on
newborns

None

Some
＊See page 11

Additional
treatments for
Caesarean
sectionRequires additional anesthetic
treatments.

Applied anesthetics can beused for Caesarean section.

Costs

Regular delivery fee

Regular delivery fee＋
Painless delivery fee

The side-by-side comparison makes it easy to understand theadvantages and disadvantages of each method.

10

STEP２

Learning the pros and cons of each option(medical knowledge about delivery methods)● Side-effects of epidural anesthesia
If you choose epidural anesthesia,
as compared with no epidural anesthesia or other methods using
painkillers, these are the possible side-effects:
 Possibility of additionally requiring labor induction increases by 1.1-fold.
 Risk of causing fever during delivery increases by 2.5-fold.
 Risk of causing hypotension during delivery increases by 11-fold.
 Risk of causing nausea and vomiting during delivery increases by 0.6-fold.
 Anesthetics may cause itching around the chest during delivery.
 Risk of causing difficulty in urination after delivery increases by 14-fold.
 Severe headache may occur after delivery in 1 to 3 out of 100 pregnant

women.
Reference: Anim-Somuah, M., Smyth, R. M., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus non-epidural or no
analgesia for pain management in labour. Cochrane Database of Systematic Reviews.

The following side-effects occur on rare occasions:

Temporary loss of feeling or strength in parts of your lower bodymay occur in 1 out of 550 pregnant women.

Life-threatening complications may occur in 1 out of 4000
pregnant women.



Death may be caused due to anesthetics on very rare occasions.

Literature：Paech, M. J., Godkin, R., & Webster, S. (1998). Complications of obstetric epidural analgesia andanaesthesia: A prospective analysis of 10995 cases. International Journal of Obstetric Anesthesia, 7(1), 5-11.

11

STEP２

Learning the pros and cons of each options★ Instrumental delivery
Instrumental delivery is more commonly used for the painless delivery
group than the natural delivery group.
No epidural anesthesia
Primiparous women

7.7 out of 100 women required
instrumental delivery in the no epiduralgroup.

Epidural anesthesia

26.2 out of 100 women required
instrumental delivery in the epidural group

Multiparous women

0.7 out of 100 women required
instrumental delivery in the no epidural
group
12

6.1 out of 100 women required
instrumental delivery in the epiduralgroup

＊Instrumental delivery is:a method for hastening delivery that is performed by using a tool suchas a suction cup or forceps when childbirth fails to progress smoothly.
Instrumental delivery provides greater benefits for the mother and baby
than letting natural delivery continue.
“Vacuum-assisted delivery” is a method in which a suction cup is
attached to the baby's head and delivery of the baby is vacuum-assisted
by applying negative pressure.
“Forceps-assisted delivery” is a method in which the forceps areused to hold the baby's head and pull out the baby.
Performing instrumental delivery sometimes requires episiotomy (amethod in which the perineum is excised by scissors for enlarging the
opening). Further, possible risks of instrumental delivery to the baby
include cephalohematoma, which is a hemorrhage found between theskull and periosteum, and facial and scalp injuries occurring during thedelivery.
Vacuum-assisted delivery

Forceps-assisted delivery

Reference： Shishido E. & Horiuchi S. Hope of delivery using epidural anesthesia during laborcompared with no anesthesia and delivery outcomes. Japanese Journal of Maternal Health 59(1),112-120.

13

STEP２

Learning the pros and cons of each option★ Postpartum urinary retention
Urinary retention is more common in the epidural group than in
the no epidural group.
No epidural anesthesia

Epidural anesthesia

7 out of 100 women had urinary
retention in the epidural group

2 out of 100 women had urinary
retention in the no epidural group

Reference： Shishido E. & Horiuchi S. Hope of delivery using epidural anesthesia during labor compared with noanesthesia and delivery outcomes. Japanese Journal of Maternal Health 59(1), 112-120.

＊Urinary retention is:
the absence of spontaneous micturition within 6 hours of vaginal
delivery.
In most cases, the symptom is eased within several days. Varyrarely, the symptom continues for more than one week and requires
self-catheterization (a method in which a tube is inserted into thebladder through the urethra to drain urine out).
Reference： Yip, S. K., Sahota, D., Pang, M. W. & Chang, A. (2005). Postpartum Urinary Retention.
Obstetrics & Gynecology. 83(10), 881－891.

14

STEP２

Learning the pros and cons of each option★ Satisfaction level with relief of labor pain
Satisfaction level of the epidural group is higher than that ofother groups using methods other than epidural (injection of opioids)with regards to relieving labor pain.
Epidural anesthesia

No epidural anesthesia

50 out of 100 women who usedmethods
other
thanepiduralanesthesia were satisfied with
their labor pain relief.

73 out of 100 women who had an
epidural anesthesia were satisfied
with their labor pain relief.

Reference: Anim-Somuah, M., Smyth, R. M., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus non-epidural orno analgesia for pain management in labour. Cochrane Database of Systematic Reviews.

＊Methods of relieving labor pain are roughly divided into two types.
a) Methods with no drug use
Breathing techniques, massage, touching, heating back by the use of a hot pack,aromatherapy, shiatsu massage, etc.
b) Methods with drug use
Painless delivery using epidural anesthesia, injection of opioids, inhalation of
nitrous oxide, etc.

15

STEP２

Learning the pros and cons of each option★ Satisfaction level with childbirth experience
Satisfaction level of the no epidural group is higher than that of
the epidural group regarding childbirth experience on an evaluation
scale of 10, with a score of 8 or higher indicating high satisfaction.
Epidural anesthesia

No epidural anesthesia

Satisfaction level withchildbirth (score)

86 out of 100 women who had a no epidural
were satisfied with their childbirthexperience

( )

出
産
満
足
度
点

60 out of 100 women who had an epidural
anesthesia were satisfied with their childbirthexperience.

10

In the epidural group, women
who were able to control theirlabor pain had a higher
satisfaction with childbirth.

9
8
7
6

Less painful
予測より痛くなかった
than expected

As expected
予測通りだった

More painful
予測より痛かった

than expected

Gap between expectation and experiencein labor pains
Reference： Shishido, E., Yaju, Y. & Horiuchi H. The gap between expectations and realities of pain and fatigue in
women receiving epidural anesthesia versus no anesthesia (2018). Journal of Japan Academy of Midwifery32(2), 101-112.

16

STEP２

Learning the pros and cons of each option★ Continuous Support
Women who had continuous support from their husband,
partner, midwife, etc. are less likely to use medications for relieving
labor pain (including painless delivery) as compared with women who
had no support during delivery.
*Continuous support includes emotional support (constantcompanionship, pain easing, cheering up), comfort measures,providing information on the progress of delivery, etc.
With support

Without support

83 out of 100 women who had continuous
support used medication for labor pain relief
during delivery.

96 out of 100 women who did not havecontinuous support used medication forlabor pain relief during delivery.

Reference: Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K. & Cuthbert, A. (2017). Continuous
support for women during childbirth. Cochrane Database of Systematic Reviews.

17

STEP２

Learning the pros and cons of each option(pain and fatigue caused by delivery)★ Pain associated with labor pain, perineal pain and after-delivery
pain

Labor pain
A higher percentage of responses for labor pain being more painful
than expected was evident in the natural delivery group.

No epidural anesthesia

Epidural anesthesia

42.5

48.5

57.5

51.5

As expected/less painful than
予測通り/予測より痛くなかった
expected
More painful than expected
予測より痛かった

As expected/less painful
予測通り/予測より痛くなかっthan expected
More painful than expected
たPerineal pain
A higher percentage of responses for perineal pain after childbirth
being very strong was evident in the epidural group.

No epidural anesthesia

Epidural anesthesia

27.7

40.4
72.3

59.6

As expected/less painful than
予測通り/予測より痛くなかった
expectedMorepainful than expected
予測より痛かった

As expected/less painful than
予測通り/予測より痛くなかった
expectedMorepainful than expected
予測より痛かった

Reference： Shishido, E. & Horiuchi S.Hope of delivery using epidural anesthesia during labor compared with noanesthesia and delivery outcomes (2018). Japanese Journal of Maternal Health 59(1), 112-120.

18

After-delivery pain
There is no significant difference in the level of after-delivery pain
between the two delivery groups.

No epidural anesthesia

Epidural anesthesia

19.3

24.1
80.7

75.9

As expected/less painful than
予測通り/予測より痛くなかった
expected
More painful than expected
予測より痛かった

As expected/less painful than
予測通り/予測より痛くなかった
expected
予測より痛かった
More painful than expected＊After-delivery pain is:labor pain occurring after the placenta is expelled from the uterus. The uterus
contracts to prevent blood loss by contracting the blood vessels exposed in thearea where the placenta was expelled and to decrease its size to the size before
pregnancy. Although after-delivery pain is irregular and weak, it can continue forapproximately 3 days after delivery and it is known that multiparous womenexperience stronger pain than primiparous women.

★ Fatigue associated with delivery
Fatigue within 2 days after childbirth
A higher percentage of responses for fatigue being stronger than
expected was evident in the epidural group.

No epidural anesthesia

Epidural anesthesia

20.7

35.5
64.5

79.3

As expected/less fatigue felt
予測通り/予測より疲れていない
than expectedMorefatiguefelt
than
予測より疲れている
expected19

As expected/less fatigue felt
予測通り/予測より疲れていない
thanexpectedMorefatigue felt than expected
予測より疲れている

Learning the pros and cons of each option(Delivery costs)
De★ Delivery costs(pain and fatigue caused by delivery)

STEP２

The following summary shows the cost difference between
natural delivery and painless delivery.

Costs

No epidural anesthesia

Epidural anesthesia

Delivery admission fee

Delivery admission fee

Painless delivery fee(approximately 100,000 to
150,000 yen)

＊Epidural anesthesia is not covered by health insurance and is thus
considered a private practice.

20

STEP３

Setting clear priorities for decision-making

In Step 2, we reviewed the pros and cons of each option. It is
important to make a decision based on correct information as well as
your own priorities that you set for that decision.
Once you set clear priorities for decision-making, it becomeseasier for you to ask for advice from a doctor or a midwife about yourdecision regarding the childbirth delivery method.
The following pages provide a tool that allows you to decide
where you place your values and thus help you set clear priorities for
decision-making. A blank space where you can write down other points
to consider is also provided.

★ Pain associated with delivery
Let us find out how important the following points are to you.
On a scale of 0 to 5, with 0 being the least important and 5
being the most important, circle the number that represents how
important each item feels to you.
PointsLess important

Consideration for my pain tolerance level
Experiencing labor pain
Reducing labor pain
Overcoming

childbirthexperience

More important

0

1

2

3

4

5

0

1

2

3

4

5

0

1

2

3

4

5

0

1

2

3

4

5

with

persons supporting you★ Side-effects of a painless delivery
Let us find out how important the following point is to you.
On a scale of 0 to 5, with 0 being the least important and 5
being the most important, circle the number that represents how
important it feels to you.
Point

Less important

Consideration for possible side-effects ofan epidural anesthesia

21

0

1

2

More important

3

4

5

★ How you go through the delivery process
Let us find out how important the following points are to you.
On a scale of 0 to 5, with 0 being the least important and 5 being
the most important, circle the number that represents how importanteach item feels to you.
PointsLess important

Being able to freely walk, eat and drink, or
go to bathroom during delivery
Painless delivery requiring longer delivery
timePainless delivery more likely requiring
instrumental delivery

More important

0

1

2

3

4

5

0

1

2

3

4

5

0

1

2

3

4

5

★ Delivery costs
This section allows you to think about the costs of painlessdelivery.
Let us find out how important the following point is to you.
On a scale of 0 to 5, with 0 being the least important and 5
being the most important, circle the number that represents how
important it feels to you.
Point

Less important

Private expense for delivery being high (or
low)

0

1

2

More important

3

4

5

★Others
Do you have anything else to consider? Write down your own
points below.
PointsLess importantMore important

0

1

2

3

4

5



0

1

2

3

4

5



0

1

2

3

4

5

22

STEP４Making your decision● Let us make sure you are ready to make a decision
regarding your childbirth delivery method
You have learned basic knowledge and thought about yourpriorities for decision-making.
Now, let us make sure you are ready to make a decision.
Check ☑ if applicable.


Do you know the benefits and risks of each option？
□ Yes □ No

Are you clear about which benefits and risks matter most to you?
□ Yes □ No

Do you have enough support and advice to make a choice?
□ Yes □ No

Do you feel sure about the best choice for you?
□ Yes □ No
The SURE Test © Légaré, et al. (2010)
Translation：Wakako Osaka et al. (2018)

If you answered “No” to at least one of the above fourquestions, you may not be ready to make a decision yet. Is there anythingelse you want to do before making your decision?
Let us sort out what you want to do by using the checklist on
the following page.

23

STEP４Making your decision●あなたがどれくらい決める準備ができているか確認しましょう。

● Let us sort out what you want to do next before taking
actionYou can set your priorities about what you want to do next before
taking action by checking off ☑ the items on the following checklist.

 None. I am ready to make my decision.
 I need to talk to (person)

about my options.

 I need to be clear about which advantages anddisadvantages matter most to me.
 Besides that, I need to do.

Many women may be figuring out what to do and how toproceed before making a decision regarding their childbirth delivery
method. Clarifying what you want to do with the help of the above
checklist will make it easy for you to take the next step.
If you feel that you still do not fully understand the available
options, you are encouraged to read the chapter “Learning the pros
and cons of each option” in this Aid again, or ask your doctor for
further explanation.
If you are still uncertain about your priorities for decision-making,you are encouraged to read the chapter “Setting clear priorities for
decision-making” again or talk to people such as midwives, family andfriends, and women who have experienced childbirth before.

24

STEP４Making your decision●How do you feel now?
How do you feel about childbirth delivery methods now? Check off ☑
the items that best matches your feelings from the list below.

I want to have an epidural anesthesia as I’m afraid ofdelivery and not sure if I can manage.
I prefer an epidural anesthesia if needed during delivery.
Until then, I’ll do my best.
I slightly favor an epidural anesthesia with minimum use ofanalgesics.
Not sure, need to think more.
I do not prefer an epidural anesthesia. However, I accept
epidural anesthesia if the pain becomes unbearable.
I want to avoid epidural anesthesia as much as possible.
However, I accept painless delivery if delivery is delayed
and it becomes difficult to proceed with vaginal delivery.
I do not want to have an epidural anesthesia.

25

In conclusion★ Process of developing this Aid
This Aid was created on the basis of opinions from women who
have experienced childbirth, doctors, nurses, midwives, and experts indecision-making research. Medical information described here waschecked by experts in obstetrics and obstetric anesthesia. This Aid does
not include all medical information, but rather basic information you
should know.
No financial support of any kind was received from healthcarerelated companies or other entities for creating this Aid (declaring noconflicts of interest).

★ For making your own informed decision satisfaction
There is no right or wrong decision about choosing whichchildbirth delivery method to use. Sharing your values and preferenceswith healthcare professionals and receiving professional opinions fromthem will allow you to make your own informed choice.
Each option has advantages and disadvantages. This Aid wascreated to help you understand the advantages and disadvantages ofeach option from a medical perspective, examine which advantages anddisadvantages are important to you according to your values, andfacilitate communication with doctors, midwives, family, colleagues andfriends, and women who have already experienced childbirth.

★ Update of information in the “Finding a Way to Relieve
Labor Pain that is Right for You” Aid
The contents of this Aid are revised and updated as needed.
Please check the revision date before using this Aid.
The information published in this Aid is to facilitate communication with healthcare
professionals, and to help you organize the information you learn and your priorities formaking decisions so that you can make up your mind about which childbirth delivery method
is right for you. This information is not intended to be a substitute for the advice of
healthcare professionals.
(Final revision of contents：January 20, 2019)26

This Aid was created on the basis of aids for choosing painless delivery that havebeen developed abroad and the references below.
＜Foreign aids used as reference＞
Pain Relief for Labour: For women having their first baby.
(The University of Sydney)www.psych.usyd.edu.au/cemped/docs/Pain_Decision_Aid.pdf[2018-04-25]
Should I Have an Epidural During Childbirth?
(Healthwise Content Development Team)https://www.mottchildren.org/health-library/tn9762[2018-04-25]＜References＞
Anim-Somuah, M., Smyth, R. M., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus
non-epidural or no analgesia for pain management in labour. Cochrane Databaseof Systematic Reviews.
Ottawa Personal Decision Guide（2004）. Translated by. N. Arimori.
http://www.kango- net.jp/decisionaid/public/pdf/otawa 01.pdf [2018-04-25]
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017).
Continuous support for women during childbirth. Cochrane Database of
Systematic Reviews.
Légaré, F., Kearing, S., Clay, K., Gagnon, S., D 'Amours, D., Rousseau, M., &O’Connor, A. (2010). Are you SURE? Assessing patient decisional conflict with
a 4-item screening test. Canadian Family Physician 56(8), 308-314.
Osaka, W. & Nakayama K. Guide to your own “decision-making”. For patientsdiagnosed with breast cancer to make a choice for surgery methods of breast
cancer with satisfaction (2014).
Paech, M. J., Godkin, R., & Webster, S. (1998). Complications of obstetric epidural
analgesia and anaesthesia: A prospective analysis of 10995 cases. International
Journal of Obstetric Anesthesia, 7(1), 5-11.
Creation of pictogram http://www.iconarray.com/about
Shishido, E. & Horiuchi S. Hope of delivery using epidural anesthesia during laborcompared with no anesthesia and delivery outcomes (2018). Japanese Journalof Maternal Health 59(1), 112-120.
Shishido, E., Yaju, Y. & Horiuchi H. The gap between expectations and realities ofpain and fatigue in women receiving epidural anesthesia versus no anesthesia(2018). Journal of Japan Academy of Midwifery 32(2), 101-112.
Yip, S. K., Sahota, D., Pang, M. W., Chang, A. (2005). Postpartum Urinary Retention.
Obstetrics & Gynecology 83(10), 881－891.

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“Finding a Way to Relieve Labor Pain that is Right for You”
Helping pregnant women make an informed decision about
epidural anesthesia and no epidural anesthesia
Authors
St. Luke's International Hospital, Ayame Henna
St. Luke's International University, Women’s Health andMidwifery, Assistant prof. Eri Shishido
Keio University, Chronic and Terminal Care Nursing,
Associate Prof. Wakako Osaka
St. Luke's International University, Graduate School,
Women’s Health and Midwifery, Prof. Shigeko Horiuchi
Medical supervision
National Center for Children's Health and Development
Obstetrician & Gynaecologist Kohei Ogawa
Date published：July 7, 20182019

Last update date：Jan. 20,

This Aid is supported by a Grant-in-Aid for Scientific Research（Ａ）17H01613 (Principal Investigator Shigeko Horiuch）.

＜Unauthorized copying or reproduction prohibited＞