Timing of decision to use epidural analgesia in laboring parturients
Abstract Number: 41
Abstract Type: Original Research
Introduction: Evidence suggests there is disparity in labor analgesia utilization in patients of different racial/ethnic backgrounds. The purpose of this study was to evaluate when patients of Caucasian, Hispanic, and African American (AA) backgrounds made their decision regarding management of labor pain and factors influencing their decision.
Methods: In this IRB-approved study, a survey was developed to assess 1) patient pain and satisfaction with the delivery experience, 2) timing of decisions about labor analgesia, and 3) factors involved in the decisions about analgesia. Patients who did not use epidural analgesia were asked questions about whether it was offered and if they understood the risks/benefits. Surveys were administered via face-to-face interviews on the first postpartum day. Racial/ethnic groups were compared using the Kruskal-Wallis statistic. P<0.05 was significant.
Results: 63 Caucasian, 31 Hispanic and 12 AA patients were interviewed, of which 10 patients (2 Caucasians and 8 Hispanics) elected not receive epidural analgesia (P=0.001). All patients said that they were offered epidural analgesia and that they understood the risks and benefits. Of the patients who used epidural analgesia, more Caucasian patients made their decision before or during pregnancy, as opposed to Hispanic and AA patients who decided during labor (Table). Analysis of the most important factor in deciding to use epidural analgesia revealed that most Caucasian patients were interested in effective pain relief (66%), whereas most Hispanic and AA patients felt they could not tolerate the labor pain, thus decided to use epidural analgesia (55% and 41% respectively) (P=0.02). Hispanic patients who received epidural analgesia experienced a higher amount of pain in labor on a NRS (0-10 scale) than the other groups (P=0.01). There was no difference in who was most influential in helping make the analgesic decisions or in the overall satisfaction with labor analgesia among groups. Nor was there a difference in satisfaction between those who received epidural analgesia versus those who did not.
Discussion: The decision to use epidural analgesia had been made before labor by most Caucasian patients, whereas Hispanic and AA patients more often needed to experience significant pain in labor before electing to use epidural analgesia. This suggests that there could be a role for early education about labor analgesia which may help Hispanic and AA patients in their decisions.