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Epidurals in labour – do women with substance abuse problems miss out?
  1. JA Scott1,
  2. N Redfern2
  1. 1Newcastle University, Newcastle upon Tyne, UK
  2. 2Royal Victoria Infirmary Hospital, Newcastle upon Tyne, UK


Introduction Maternity standards state ‘all pain relief should be available for all women’.1 There are concerns as to whether women with substance abuse are offered the full range of analgesic options, and hence receive appropriate analgesia.

Aims To determine if the analgesia use of women in labour with substance abuse, differs from that of labouring women without substance abuse.

Methods A 12 month (February 2008–February 2009) audit identified 39 women with alcohol and/or drug abuse problems. A comparator group of 111 women with no substance abuse, who gave birth in the same unit during a similar period, was identified. For both groups details of labour and delivery and the type and timing of analgesia were recorded.

No substance abuse (n=111)Substance abuse (n=39)
Analgesia92 (83%)31 (79%)χ2=0.225
DF=1, p=0.635
Opiates37 (33%)17 (43%)χ2=1.318
DF=1, p=0.635
Epidural33 (29%)4 (10%)χ2=5.890
DF=1, p=0.01

Analgesia use in labour

Results Non-epidural analgesia and opiate use in labour was similar for women in both groups. By contrast, while 29.7% of women without substance abuse received epidural analgesia in labour only 10% of women with a substance abuse background (p=0.015 – table below) had an epidural.

Discussion Epidural use among women with substance abuse is one third of that of women with no substance abuse. Further study is needed to determine if this difference is due to the approach of professionals offering analgesia, an aversion in women with substance abuse to epidurals and/or practical difficulties to placing epidurals in these parturients.

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