The Effects of Epidural Analgesia on Maternal-Infant Bonding and Birth-Related Trauma

This prospective, randomized, controlled, single-center clinical trial that will be conducted at Adıyaman University Training and Research Hospital, Department of Obstetrics and Gynecology. The aim is to investigate the impact of epidural analgesia on maternal-infant bonding and birth-related psychological trauma among women undergoing spontaneous vaginal delivery.

Eligible participants will include pregnant women aged between 18 and 40 years with ASA physical status I or II, who are planning vaginal delivery. Women with contraindications to epidural analgesia, morbid obesity, previous local anesthetic toxicity, or indications for cesarean section will be excluded.

Based on a priori power analysis, 40 participants will be recruited into each group to account for potential dropout, totaling 80 participants. Group E will consist of women who receive epidural analgesia during labor, while Group C will include those who undergo vaginal delivery without any epidural intervention.

Epidural analgesia will be administered via catheter placement at the L3-L4 vertebral level. Following a test dose with lidocaine, patients will receive a combination of 0.2% bupivacaine and 25 mcg fentanyl once cervical dilatation reaches 5 cm. Additional boluses may be administered as required based on pain levels.

Participants will be assessed for pain intensity using the Visual Analog Scale (VAS) during and after delivery. Postpartum satisfaction and early breastfeeding status will be recorded prior to discharge. At one month postpartum, all participants will complete validated questionnaires, including a birth-related trauma scale(City Birth Trauma Scale) and the Maternal Attachment Inventory, to assess psychological outcomes and maternal-infant bonding.

The results of this study are expected to contribute to a better understanding of the psychological and emotional consequences of epidural analgesia in vaginal deliveries and help optimize maternal care practices.

Inclusion criteria

• Female participants aged between 18 and 40 years
• ASA physical status classification I or II
• Pregnant women undergoing spontaneous vaginal delivery at the study hospital
• Willingness to provide informed consent and participate in study procedures

Exclusion criteria

• Age below 18
• ASA physical status classification III or IV
• Morbid obesity (BMI ≥ 40 kg/m²)
• Indication for cesarean section
• History of local anesthetic toxicity or allergy
• Contraindications to epidural analgesia (e.g., coagulopathy, infection at insertion site)
• Any significant maternal or fetal complication that contraindicates study participation