Labour epidurals in Gauteng Province, South Africa

J Wagner, S Chetty, F Paruk, P Kamerman


Background. Inadequately controlled labour pain is associated with numerous deleterious physiological and psychological effects. Epidural labour analgesia is accepted as the gold standard. 

Objectives. To establish the frequency of labour epidural analgesia for vaginal and caesarean section delivery in Gauteng Province (GP) private and public hospitals. 

Methods. GP maternity hospitals belonging to the three largest private hospital groups, and public academic, tertiary, regional and district maternity hospitals, were approached for inclusion in the study. A total of 24/47 private hospitals and 21/26 public hospitals agreed to participate in the present study and data from these hospitals were included in the data analysis. This was a retrospective study, and the delivery statistics and registers for 2015 were examined from all participating hospitals. Consecutive convenience sampling was applied. 

Results. A total of 3 560 labour epidurals were placed in the 45 participating hospitals in GP in 2015. About two-thirds (62%; n=2 208) of these labour epidurals were placed in the private sector. The median (interquartile range (IQR)) annual epidural frequency for all participating private hospitals was 6% (1.37 - 8.42). Only two public hospitals in GP were able to offer labour epidural services in 2015 and the annual proportion of deliveries with epidural placement was 4.1%. Both hospitals were academic hospitals affiliated with a single university. 

Conclusion. Similar to other developing countries, the labour epidural rates in GP hospitals were well below international labour epidural rates in 2015. This lack of service provision may be compromising patient care as well as the training of healthcare professionals.

Authors' affiliations

J Wagner, Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Chetty, Department of Anaesthesiology and Critical Care, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa

F Paruk, Department of Critical Care, Faculty of Health Sciences, University of Pretoria, South Africa

P Kamerman, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia

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Cite this article

South African Journal of Obstetrics and Gynaecology 2020;26(3):99-104. DOI:10.7196/sajog.1636

Article History

Date submitted: 2021-05-24
Date published: 2021-05-24

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