Discussing the risk and benefits of an epidural to a laboring woman can be a difficult task.
Obtaining consent for the procedure whilst the pain, the anxiety, and the necessity of acting
fast because of an active labor are added to the overwhelming quantity of information a
laboring woman receive is among the challenges anesthesiologist must face before doing an
epidural. The validity of the consent of a labouring women has already been proven in several
studies. Indeed, it has been shown by that pain, either mild or severe, has no impact on the
retention of epidural risks that have been explained. However, there is a significant
variability regarding risk disclosure within different practice settings, particularly with
respect to the incidence of serious complications. In studies, knowledge about the epidural
and retention of information given at the time of consent remains poor, but could be improved
by a learning tool (e.g., video, explanatory leaflet)
At the investigators's institution, standardized risks are exposed to the patient during the
epidural technique. The five risks mentioned are hypotension, lumbar pain, failure (10%),
risk of dura mater puncture (1%) and post-puncture headache as well as severe nerve injury up
to paralysis (1/200 000). These risks are checked off on the anesthesia sheet when discussed
with the patient. Groupe "before" will be asked about recall of risk and information giving
after standard consent counseling. Groupe "after" will be exposed to an informative document
explaining the risk as soon as active labour was confirmed. Participants will also have usual
consent information standardized by local practice.
On post-partum day 1, participants will be asked about the risks exposed at the moment of
consent regarding epidural analgesia by means of a questionnaire. The questionnaire
distributed to patients contains true and false statement about the epidural and they will be
asked about the truth of information. No additional information about the epidural will be
disclose to the patients during the questionnaire. Group "before" will also be asked
questions about how they would like to receive information concerning epidural and group
"after" will be asked about if they appreciate receiving an informative brochure.
The informative document will be created by the study team and sent to the anesthesia and
obstetrics teams in at study team's hospital for pre-approval. The maternity nurses will be
asked to give the document as soon as the patient will be admitted to the ward. Before being
recruited, parturient will have to ensure that they had indeed read the document before
receiving epidural analgesia.
The aim of this before-and-after study is to evaluate the impact of adding an information
document available at the admission for active labour on improving the knowledge of patients
receiving epidural anesthesia as well as its effectiveness on retention of the risks
explained at the time of consent. In addition, one of the sub-objectives is to identify which
factors influence risk retention in order to eventually better adapt our pre-epidural
counseling.