Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration related factors

Vigdis Aasheim,Roy M Nilsen,Eline Skirnisdottir Vik,Rhonda Small,Erica Schytt

doi:10.1016/j.srhc.2020.100553

Abstract

ObjectiveTo investigate associations between maternal country of birth and other migration related factors (length of residence, reason for migration, paternal origin) and epidural analgesia for labour pain in nulliparous women in Norway. DesignPopulation-based register study including nulliparous migrant women (n = 75,922) and non-migrant women (n = 444,496) with spontaneous or induced labour. Data were retrieved from the Medical Birth Registry and Statistics Norway, 1990–2013. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression, and adjusted for maternal age, marital status, maternal education, gross income, birth year, hospital size and health region. Main outcomeEpidural analgesia for labour pain. ResultsEpidural analgesia was administered to 38% of migrant women and 31% of non-migrant women. Compared with non-migrants, the odds of having epidural analgesia were lowest in women from Vietnam (adjOR 0.54; CI 0.50–0.59) and Somalia (adjOR 0.63; CI 0.58–0.68) and highest in women from Iran (adjOR 1.32; CI 1.19–1.46) and India (adjOR 1.19; CI 1.06–1.33). Refugees (adjOR 0.83; CI 0.79–0.87) and newly arrived migrants (adjOR 0.92; CI 0.89–0.94) had lower odds of epidural analgesia. Migrant women with a non-migrant partner (adjOR 1.14; CI 1.11–1.17) and those with length of residence ≥10 years (adjOR 1.06; CI 1.02–1.10) had higher odds. ConclusionThe use of epidural analgesia varied by maternal country of birth, reason for migration, paternal origin and length of residence. Midwives and obstetricians should pay extra attention to the provision of adequate information about pain relief options for refugees and newly arrived migrants, who had the lowest use.

Highlights

Disparities in maternity care between migrant and non-migrant pregnant women is a well-known challenge [1]
Higher rates of epidural analgesia are associated with factors related to high pain intensity, such as nulliparity [7,8], induced labour [9] and a large infant [10], and with socio-economic factors, such as higher education and income [7,10] and advanced maternal age [8], and lower rates are associated with one-to-one intrapartum continuous support [3]
The prevalence of epidural analgesia increased over the study years and the increase was similar for both migrant and non-migrant women (Supplementary Table 1)

Summary

Introduction

Disparities in maternity care between migrant and non-migrant pregnant women is a well-known challenge [1]. Higher rates of epidural analgesia are associated with factors related to high pain intensity, such as nulliparity [7,8], induced labour [9] and a large infant [10], and with socio-economic factors, such as higher education and income [7,10] and advanced maternal age [8], and lower rates are associated with one-to-one intrapartum continuous support [3] This indicates that the decision to offer a woman epidural analgesia is influenced by a range of factors: the woman’s preparedness for what to expect during labour and birth [11], her expression of pain and her own preferences [12], her knowledge about what can be offered, the quality of labour support she is given [3], the midwives’ attitudes and local practice in the delivery unit [11,12]. All these factors may differ in the care of migrant and non-migrant women [2]

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Discussion

Conclusion