Neuraxial Labor Analgesia in China: Progress, Challenges

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Neuraxial Labor Analgesia in China: Progress, Challenges, and What’s Holding Back Pain-Free Labor

Labor pain is one of the most intense experiences a woman can face—but for decades, access to safe, effective relief like neuraxial labor analgesia (NLA) has been limited in China. Back in 2006, just 13% of Chinese hospitals offering NLA provided 24-hour service—compared to 90% of UK centers a decade earlier. How has this changed? A 2018 survey of over 2,000 Chinese hospitals sheds light on progress, challenges, and what’s holding back wider access to pain-free labor.

What the Survey Found

Conducted by researchers from the Department of Anesthesiology at Union Hospital, Tongji Medical College (Huazhong University of Science and Technology), the study targeted directors and vice-directors of anesthesia departments at model public hospitals. Approved by the Obstetrics Group of the Chinese Medical Association, it collected responses via an online platform (Wenjuan) and verified conflicting answers by phone.

Of 2,344 valid responses:

  • 67% of hospitals (1,382) offered NLA—a big jump from 2005, when just 16% of Chinese people had even heard of the procedure.
  • Only 14.5% (201) had 24/7 anesthesiologist coverage for labor wards. That means most women can’t access NLA outside regular working hours.
  • Most NLA cases (63%) were requested by laboring women—a sign of growing awareness and demand. Just 37% were proactively recommended by doctors.
  • Over half of hospitals (53%) performed fewer than 100 NLA procedures in 2017—showing that even where available, use remains low.
  • Epidural analgesia was the top method (79% of hospitals), with nearly 90% using opioids alongside local anesthetics to boost pain relief.

The Biggest Barrier: Not Enough Anesthesiologists

For hospitals that suspended or never offered NLA (1,609 total), 69% cited a shortage of anesthesiologists as the main obstacle. This is a critical issue: China has roughly 20 anesthesiologists per 100,000 people—far fewer than the 50+ recommended by the World Health Organization.

Other challenges? Misalignment between the risk of NLA (rare but serious complications) and anesthesiologists’ pay, plus long work shifts that make 24/7 coverage unsustainable for understaffed teams.

Progress and Hope

There’s good news too:

  • Demand is rising: More women are asking for NLA because of its proven effectiveness and high satisfaction rates.
  • Public initiatives work: Programs like the No Pain Labor & Delivery-Global Health Initiative (NPLD-GHI), founded at Northwestern University Feinberg School of Medicine, have helped increase epidural use in China. National health projects have also raised awareness.
  • Policy shifts: China is integrating NLA into national health insurance—making it more affordable for millions of pregnant women (18 million yearly, thanks to the 2016 two-child policy).

What’s Next?

The survey makes it clear: While NLA access has improved, it’s still far from universal. To fix this, China needs to:

  1. Train more anesthesiologists.
  2. Balance pay, risk, and work hours for labor ward staff.
  3. Expand 24/7 coverage to meet demand from laboring women.

This article is based on research by Gao-Hong Di, Shang-Long Yao, Jie Wang, Zhi-Lin Wu, Huan Liu, and Hui Wang, published in the Chinese Medical Journal (2020;133(5):613–614). doi:10.1097/CM9.0000000000000529

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