Patient satisfaction, access barriers, and maternal outcomes following epidural analgesia during labor in two west bank hospitals: a prospective comparative observational cohort study

Epidural analgesia is increasingly used in West Bank hospitals; however, evidence regarding women’s satisfaction, access barriers, and outcomes remains limited. This prospective comparative observational cohort study at two public tertiary hospitals in the northern West Bank (June–December 2025) enrolled 340 women with epidural analgesia and 340 without (total N = 680). Clinical outcomes were obtained from medical records; patient-reported outcomes were assessed using anonymous questionnaires. The original sample size was based on maternal hypotension; however, the study’s principal focus, patient satisfaction, was emphasized due to its clinical and public health relevance, with post-hoc power exceeding 99% for satisfaction analyses. Patient satisfaction was the principal focus, with maternal/neonatal outcomes as secondary exploratory endpoints. The epidural utilization rate was 29.1% (340/1,168 vaginal deliveries; 95% CI: 26.5–31.8%). Satisfaction with pain relief was higher with epidural analgesia (74.1% vs. 40.0%; RR = 1.85, 95% CI: 1.60–2.15; ARD = 34.1%, 95% CI: 26.7–41.5%). Among women without epidural analgesia, 31.2% cited anesthesia team unavailability, indicating structural access barriers; 42.1% reported personal preference, 17.9% cited safety concerns, and 8.8% had medical contraindications. As secondary exploratory findings, hypotension (40.6% vs. 10.0%; RR = 4.06, 95% CI: 2.87–5.74) and urinary retention (102 [30.0%] vs. 27 [7.9%]; RR = 3.78, 95% CI: 2.55–5.60) were more frequent with epidural analgesia, of these, 42 women in the epidural group resolved spontaneously without catheterization, and 60 required catheterization, while neonatal outcomes showed no clear differences (NICU admission: 5.9% vs. 5.3%; RR = 1.11, 95% CI: 0.60–2.06). In this cohort, epidural analgesia was associated with substantially higher satisfaction. Nearly one-third of women without epidural analgesia reported structural barriers rather than personal preference, highlighting a gap in service provision relevant to WHO/WFSA equitable access recommendations. Secondary maternal outcome differences should be interpreted cautiously as these analyses were exploratory, unadjusted, and observational.