Impact of midwife clinical experience and survey-based attitudes towards labor epidural analgesia on utilization rates in pregnant patients: a survey-based cohort study
Authors' conclusion
Midwives' clinical experience and attitudes toward LEA influence its use in the deliveries they attend, particularly among primiparous patients.
Study context
- Population
- Term singleton vaginal deliveries at a tertiary center, 2020–2025, linked to the admitting midwife35 midwives surveyed
- Participants
- 10,080 deliveries
- Exposure
- Midwife clinical experience and attitudes towards labor epidural analgesia (LEA) vs LEA use
- Outcome
- LEA use
Methodological detailssingle tertiary centre, principal component analysis, multivariable regression stratified by parity
- Single tertiary centre
- Principal component analysis
- Multivariable regression stratified by parity
Main finding
As reported in the abstract
LEA use by midwife experience
Odds ratio (95% CI)
Each additional year of experience (primiparas)
0.83(0.76–0.92)
Each additional year of experience (multiparas)
0.84(0.79–0.89)
Each additional year of experience, as printed
- Overall LEA rate
- 63.5%
- LEA use decreased with midwife experience
- P < 0.001
Observational data: associations, not effects.
Further findings
Higher LEA-related concern score (PC1)
| OR (95% CI) | ||
|---|---|---|
| Higher PC1 (primiparas) | 0.94 (0.89–0.99) | |
| 0.512Odds ratio (log scale) |
- Not associated with LEA odds among multiparas
Patient factors associated with LEA
- More common among primiparas, lower cervical dilation at admission, oxytocin induction
- P < 0.001
Original publication
Impact of midwife clinical experience and survey-based attitudes towards labor epidural analgesia on utilization rates in pregnant patients: a survey-based cohort study. Int J Obstet Anesth. Published 25 October 2025. doi:10.
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