Papers of the Week

Besides neuraxial analgesia, non-pharmacological methods are also proposed to help women coping with pain during labor. We aimed to identify the individual and organizational factors associated with the use of non-pharmacological analgesia for labor pain management. Women who attempted vaginal delivery with labor analgesia were selected among participants included in the 2016 National Perinatal Survey, a population-based cross-sectional study. Labor analgesia was studied as neuraxial analgesia alone, non-pharmacological analgesia alone, and neuraxial and non-pharmacological analgesia combined. The associations were studied by multilevel multinomial logistic regression. Among the 9,231 women included, 62.4% had neuraxial analgesia alone, 6.4% had non-pharmacological analgesia alone and 31.2% had both. Non-pharmacological analgesia alone or combined with neuraxial analgesia were both associated with high educational level (adjusted odds ratio 1.55; 95%CI, 1.08 to 2.23 and 1.39; 95%CI, 1.18 to 1.63), antenatal preference to deliver without neuraxial analgesia, and public maternity unit status. Non-pharmacological analgesia alone was more frequent among multiparous women, and in maternity units with an anesthesiologist not dedicated to delivery unit (1.57; 95%CI, 1.16 to 2.12) and with the lowest midwife workload (2.15; 95%CI, 1.43 to 3.22). Neuraxial and non-pharmacological analgesia combined was negatively associated with inadequate prenatal care (0.70; 95%CI, 0.53 to 0.94). In France, most women who had non-pharmacological analgesia during labor used it as a complementary method to neuraxial analgesia. The use of non-pharmacological analgesia combined with neuraxial analgesia mainly depends on the woman's preference, but also on socioeconomic factors, quality of prenatal care and care organization.