Decisional regret following avoidance of epidural analgesia in labor

Epidural analgesia (EPA) is a commonly employed technique of providing pain relief during labor. However, a subset of women elects to avoid this option, motivated by personal, cultural, or medical reasons. While the clinical outcomes of EPA have been widely studied, the emotional consequences of declining it, specifically decisional regret remain underexplored. To evaluate the prevalence of decisional regret among women who chose not to undergo EPA prior to delivery and identify clinical and demographic predictors associated with regret. We identified women documented as having chosen to avoid epidural analgesia (EPA) before delivery at our tertiary care center between 2021 and 2023. Inclusion criteria were age > 18 years and fluency in Hebrew; women with intrauterine fetal death and those who wanted EPA but did not get it were excluded. Clinical and demographic data were collected from medical records. Participants completed the Decision Regret Scale (DRS) by telephone interview. Regret was categorized as none (score 0), mild (1–25), and moderate-to-strong (26–100). Descriptive statistics, Wilcoxon rank-sum and Fisher’s exact tests, and multivariable logistic regression were used for analysis. Of 207 eligible women, 200 (97%) completed the DRS at a median of 20 months postpartum. Any decisional regret (DRS > 0) was reported by 40% of participants; among women reporting regret, 95% had mild regret and only 4 women (2% of the total cohort) had moderate-to-strong regret. Absence of prior EPA experience was associated with greater odds of regret in the multivariable model (OR 5.69, p = 0.002). No significant associations were observed for age, parity, education, IVF conception, or maternal adverse events. Any decisional regret was frequent among women who declined epidural analgesia during labor, but it was almost always mild; only 2% of the cohort reported moderate-to-strong regret. Women without prior EPA experience appeared more likely to report regret. These findings support careful prenatal counseling and shared decision-making while highlighting the need for larger prospective studies with contemporaneous measures of pain and decision-making.