Exploring Factors Influencing Patient Request for Epidural Analgesia on Admission to Labor and Delivery in a Predominantly Latino Population

Abstract

Ethnic disparities in labor pain management exist. Our purpose is to identify patients' attitudes and beliefs about epidural analgesia in order to develop a culturally competent educational intervention. A prospective observational study was conducted in patients admitted for vaginal delivery between July 1st-31st, 2009. Inclusion criteria were: singleton, term, cephalic, normal fetal heart tracing and no contraindications for epidural. Patients were surveyed regarding their wishes for analgesia, and their reasons for declining epidural. The obstetrics physician performed pain management counseling as is usually done. Patients were asked again about their choice for analgesia. Likert scale questionnaires were used. Wilcoxon signed ranked test was used for categorical variables. Logistic regression was performed to look for predictors of epidural request. Fifty patients were interviewed. Average age was (27.9 ± 6.7), gestational age (39.3 ± 1.3), and a median parity of 2 (range 0-6). 72% declined epidural upon admission, and 61% after counseling (P = 0.14). Most common reasons for declined epidural were 'women should cope with labor pain' (57%), 'fear of back pain' (54%) and 'family/friends advise against epidural' (36%). Acculturation was assessed by years living in the US (10 ± 6.3), preferred language (Spanish 80%) and ethnic self-identification (Hispanic 98%). 38% were high school graduates. In multivariate logistic regression, graduation from high school was the only variable associated to request for epidural in labor (OR 4.94, 95% CI 1.6-15.1). Educational level is associated to requesting an epidural in labor. Knowledge of patients' fears and expectations is essential to develop adequate counseling interventions.