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Utilization Rates of Labor Analgesia in an Academic Health Center Among Native American Parturients
Abstract Number: S1A-5
Abstract Type: Original Research
Disparities in utilization rates of epidural analgesia among minorities (Hispanic & African American women) have been previously described (1). However, there is little information on the usage of epidural analgesia in the Native American population.
A survey was developed that collected data on ethnicity, religion, economic status, pregnancy/prenatal care, and education on epidurals. The survey was administered in the post partum period to women who underwent vaginal delivery and took 5-10 minutes to complete. For this sub-analysis, data from women who self-identified as native American were analyzed.
A total of 600 laboring women were recruited for the study. Of those, 60 self-identified as Native American (NA) and were included in for this subanalysis. Continuous variables were compared with Wilcoxon-Mann-Whitney test and binary variables with Fisher’s Exact Test. 43.3% of Native Americans in the study (26/60) received epidural analgesia. Native American women who received epidural analgesia during labor were more likely to have had an epidural during a previous delivery, and more likely to know prior to labor that they wanted an epidural (p<0.05). Women who received epidural analgesia also showed a trend toward more likely to be single (50% vs. 32.4%), younger (25.4 yrs vs. 27.5yrs), and primiparous (42.3% vs. 26.5%), although these did not reach statistical significance. There was no difference between the 2 groups in primary service of prenatal care (FM, OB, CNM), number of prenatal visits, or insurance coverage. 23% of women in the epidural group and 17.4% of women in the non-epidural group reported a family member tried to convince them not to have an epidural. Of note, 27/60 (45%) of women in the study reported household incomes of <10K per year.
Little has been published on utilization rates of epidurals among Native American women. Within our cohort, 43.3% of self-identified NA women utilized epidural analgesia for vaginal delivery, this is below previously published utilization rates among Caucasian (68%), and similar to Hispanic women (47.7%). (1)
(1) Osterman MJ, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area. Natl Vital Stat Rep 2011;59:1-1316.