Social Disparities Influence Epidural Use During Childbirth, Study Finds


A recent study conducted by researchers at Columbia University Mailman School of Public Health and Columbia Vagelos College of Physicians and Surgeons (P&S) has revealed that social inequity is linked to lower use of neuraxial analgesia, specifically epidurals or spinal pain relievers, among non-Hispanic white women and African American women. The findings, published in Obstetrics & Gynecology, highlight the need to address social inequities in order to improve pain management during childbirth and reduce racial disparities in maternal health outcomes.

Neuraxial analgesia, which includes techniques such as combined spinal and epidural analgesia, is considered the most effective method for pain relief during labor and has been shown to reduce severe maternal morbidity. In the United States, approximately three-quarters of women in labor receive neuraxial analgesia. However, the study found that African American women are approximately 10% less likely to receive this pain relief method compared to white women.

The study identified several factors that contribute to the lower utilization of neuraxial analgesia among African American women. These include patient preference, often due to inadequate prenatal education on pain management options during labor, and limited access to labor neuraxial analgesia in the delivery hospital, which can be attributed to the absence of a dedicated obstetric anesthesia team available 24/7.

Social inequity and racism are also significant contributors to the racial and ethnic disparities observed in the use of labor neuraxial analgesia. Jean Guglielminotti, MD, Ph.D., assistant professor of anesthesiology at Columbia P&S and first author of the study, emphasized that structural, institutional, and interpersonal racism must be addressed in order to improve access to perinatal care and reduce racial disparities in maternal health outcomes.

To examine the association between social inequity and the use of labor neuraxial analgesia, the researchers analyzed data from 1.7 million African American and white women in labor across 45 U.S. states and the District of Columbia in 2017. Social inequity was measured using an index based on the Black-to-white inequity ratios in low education rates, unemployment rates, and incarceration rates.

The study revealed that in counties with the highest social inequity index, 78% of white women and 72% of African American women received labor neuraxial analgesia. After adjusting for demographic and clinical characteristics, African American women had a 17% decreased odds of receiving this form of pain relief compared to white women.

Furthermore, the study found that giving birth in counties with high social inequity was associated with a 16% decrease in neuraxial analgesia use among white women and a significant 28% decrease among African American women, when compared to counties with low social inequity.

Guglielminotti highlighted an important finding of the study, noting that social inequity negatively impacts both white and African American women. This suggests that the healthcare system may not be operating optimally when racism undermines policies, practices, and procedures, ultimately affecting all individuals who seek care.

These findings underscore the need for comprehensive efforts to address social inequities and racial disparities in maternal health. By improving access to prenatal education and ensuring adequate availability of pain management options during labor, healthcare providers and policymakers can work towards providing equal and effective care for all women, regardless of race or ethnicity.


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