The Disparity in Epidural Use Among Women in Labor
One of the most effective ways to relieve pain during labor is neuraxial analgesia, which includes epidural and spinal injections. However, not all women in labor have equal access to this option, especially African American women and women living in counties with high social inequity. A new study by researchers at Columbia University reveals how social inequity and racism contribute to the lower use of epidural among women in labor in the U.S.
The study, published online in Obstetrics & Gynecology, used data from 1.7 million African American and white women in labor in 45 U.S. states and the District of Columbia in 2017. The researchers calculated social inequity based on the ratios of low education, unemployment, and incarceration rates between Black and white populations in each county.
They found that social inequity was associated with lower use of epidural among both white and African American women, but the effect was more pronounced for the latter group. Compared to white women, African American women had a 17% lower chance of receiving epidural during labor. Moreover, giving birth in a county with high social inequity reduced the odds of epidural use by 16% for white women and by 28% for African American women.
The Implications of Lower Epidural Use for Maternal Health
The lower use of epidural among women in labor has significant implications for maternal health outcomes, as epidural can help prevent severe maternal morbidity, such as postpartum hemorrhage, infection, and cardiac arrest. The study suggests that addressing social inequity in education, employment, and criminal justice could improve pain management for childbirth and reduce racial disparities in maternal health.
The researchers also identified some of the possible mechanisms that account for the lower use of epidural among African American women, such as patient preference and hospital access. They noted that some African American women may prefer other methods of pain relief or may have insufficient prenatal education on the benefits and risks of epidural. They also pointed out that some hospitals may not have a dedicated obstetric anesthesia team or may have policies that limit the availability of epidural.
The study’s lead author, Jean Guglielminotti, MD, PhD, assistant professor of anesthesiology at Columbia, said that social inequity and racism could be significant contributors to the lower use of epidural among women in labor. He said that racism, in its various forms, could affect the quality and accessibility of perinatal care for African American women and other women of color.
The Recommendations for Improving Epidural Use and Maternal Health
The study’s authors offered some recommendations for improving epidural use and maternal health among women in labor, especially those who face social inequity and racism. They suggested that health care providers should provide culturally competent and patient-centered education on pain management options for childbirth, and that hospitals should ensure adequate staffing and resources for obstetric anesthesia services.
They also called for more research on the factors that influence epidural use and maternal health outcomes, such as patient satisfaction, provider bias, and insurance coverage. They emphasized the need for a multidisciplinary and multisectoral approach to address the root causes of social inequity and racism that affect maternal health.
The study’s senior author, Guohua Li, MD, DrPH, professor of epidemiology and anesthesiology at Columbia, said that epidural is a safe and effective way to relieve pain during labor, and that every woman in labor should have the opportunity to choose it. He said that improving epidural use and maternal health requires a comprehensive and coordinated effort from policy makers, health care providers, and community leaders.