Spinal analgesia during childbirth in Sweden: a nationwide survey of midwives´ perspectives

Abstract Pain is a central symptom during childbirth. Compared to epidural analgesia, labour spinal analgesia (LSA) has received little attention, and no study has previously examined midwives´ attitudes toward LSA. This nationwide, mixed-methods survey study explored Swedish midwives´ experiences, perceptions, and use of LSA during vaginal childbirth. A 16-item questionnaire was distributed to 1,756 midwives, of whom 943 (53.7%) responded; the largest proportion was from the Stockholm–Gotland region (67.7%). Most midwives with LSA experience perceived it as effective (96.0%). Experience (number of women assisted with LSA) was categorized as none (4%), low (34.6%, 1–9 women), moderate (38.5% 10–49 women), or high (22.9% ≥ 50 women). Common indications included multiparity, previous rapid labour, and difficult-to-manage pain; the most common limiting factor was concern that the analgesia would wear off before birth. In multivariable penalized logistic regression analysis, working in a university region was associated with lower odds of LSA experience (aOR 0.09, 95% CI 0.01–0.39). Reflexive thematic analysis of 791 free-text responses resulted in two themes: Effective pain relief within limits of progress and Critical timing as a clinical concern . Respondents expressed strong interest in education on LSA. Further research and interprofessional collaboration are warranted to clarify LSA´s role in obstetric analgesia.