Maternal Perception of Nursing Support in Labor and Use of Epidural Anesthesia
Authors:   , Riffel Kim 
Published: February 2023

Use of epidural anesthesia during labor has become prevalent, although epidural use has been associated with a number of undesirable childbirth outcomes (MacArthur, Lewis, & Knox, 1992; Nicholson & Ridolfo, 1989: Scott & Hibbard, 1990; Thorp et aI., 1993). Because supportive nursing care has been linked to a number of favorable childbirth outcomes, the relationship between maternal perception of the occurrence and helpfulness of nursing support behaviors and use of epidural anesthesia in labor was examined using a retrospective, descriptive investigation with a convenience sample of 38 primiparous women. Humenick's (1981) Mastery Model was used as the theoretical base for this investigation, resulting in childbirth being viewed as a psychologically important task. Mastery of childbirth is theorized by Humenick as being linked to a woman's definition of control and her perception of her ability to maintain control during labor and birth. Three categories of nursing support were compared in participants who used epidurals and those who did not. The nursing support categories included (a) emotional (reassuring, giving the feeling that one is cared about); (b) tangible (direct aid, such as taking care of someone or doing a job); and (c) informational (providing information or advice and giving feedback) (Bryanton et al., 1994). The Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) was mailed to women 2-3 weeks postpartally. Data related to nursing support, as well as demographics, the childbirth experience and epidural use, were elicited. Group means revealed a higher overall mean rating of nursing support in the nonepidural group (M = 4.45) compared to the epidural group (M = 4.30). However, no significant relationship was found between epidural use and emotional, tangible, or informational nursing support, or overall nursing support behavior helpfulness. Higher overall helpfulness of nursing support behaviors was found to be significantly related to a shorter labor (t[31] = -2.22, p. = .03) and higher infant birth weight (chi2 = 12.36, df = 1, p &lt; .05). Labor length was positively correlated with epidural use (t[22] = 2.62, p = .02); maternal age was negatively correlated with epidural use (t[36] = -1.73, p = .05). An association was found between use of the epidural and the woman's choice regarding the epidural made during, as opposed to before, labor (chi2 = 4.58, df = 1, p &lt; .05). Epidural use was linked to a maternal perception of physician preference for the epidural (chi2 = 11.49, df = 2, p &lt; .05). The use of medical interventions in labor and delivery, including augmentation of labor and instrumental assistance for delivery, was also significantly associated with epidural use (chi2 = 10.26, df =3, p &lt; .05). Results from this investigation suggest that the helpfulness of nursing support in labor may be a factor in influencing use of epidural anesthesia, but a small sample size may have contributed to the lack of statistical significance. Variations in the ways women choose to achieve mastery of childbirth, or in nurses' performance of the support behaviors, may help to explain differences that occurred in ranking of the behaviors between epidural and nonepidural groups. The findings suggest the need for additional research with a larger sample size, including consideration of factors such as the woman's perceived pain level, the type of information received in childbirth preparation, and the woman's orientation toward medical interventions versus \natural\ childbirth. Recommendations include the need to better coordinate childbirth education with nursing practice in labor, and to examine more closely the importance of the nurse's role related to technological support versus supportive care.