Conn EB, Keren R; AcademyHealth. Meeting (2004 : San Diego, Calif.).

Abstr AcademyHealth Meet. 2004; 21: abstract no. 1203.

University of Pennsylvania/Children's Hospital of Philadelphia, Pediatrics, 166 Gramercy Road, Bala Cynwyd, PA 19004 Tel. 267.679.4017 Fax 215.590.0426

RESEARCH OBJECTIVE: The decision to use epidural anesthesia during childbirth is a complex one, involving considerations of patient preferences, obstetric history, and provider practice style. The objective of this study was to explore the relationship of obstetric and sociodemographic factors to receipt of epidural anesthesia during labor and vaginal delivery. STUDY DESIGN: This was a retrospective cohort study. The outcome variable was receipt of epidural anesthesia during labor and vaginal delivery. The predictor variables were obstetric and sociodemographic factors. POPULATION STUDIED: The population studied was 2568 women who delivered vaginally between 1993 and 1997 at an urban community teaching hospital in Pennsylvania and took part in the hospital supervised early discharge follow-up program. PRINCIPAL FINDINGS: 1753 (68.26%) women received epidural anesthesia during labor. In a multivariable logistic regression model, the following factors were associated with receipt of epidural anesthesia: race/ethnicity (as compared to white): African American (odds ratio [OR] = 0.75; 95% confidence interval [95 % CI], 0.57-0.97), Hispanic (OR = 0.70; 95% CI, 0.42-1.19), Asian (OR = 0.47; 95% CI, 0.30-0.72), and other (OR = 0.42; 95% CI, 0.19-0.93); infant birth weight (/kg) (OR = 1.37; 95% CI, 1.07-1.75); forceps delivery (OR = 11.79; 95% CI, 4.59-30.25); vacuum delivery (OR = 2.53; 95% CI 1.75-3.67); oxytocin induction or augmentation (OR = 6.01; 95% CI, 4.91-7.36); and parity (OR = 0.75; 95% CI, 0.69-0.82). The model controlled for median household income, maternal age, driving time to the hospital, gestational age, prolonged rupture of membranes, and the gender of the infant. CONCLUSIONS: Controlling for known predictors of epidural anesthesia, women of Asian, African American, and other racial background received epidural anesthesia during labor and vaginal delivery less often than white women. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Additional research is needed to understand whether healthcare system factors, educational and cultural differences, patient preference, and/or provider bias are responsible for these disparities.

Publication Types:

• Meeting Abstracts

Keywords:

• African Americans
• Anesthesia, Epidural
• Birth Weight
• Cohort Studies
• Confidence Intervals
• Delivery, Obstetric
• European Continental Ancestry Group
• Female
• Hispanic Americans
• Humans
• Infant
• Labor Stage, Second
• Labor, Obstetric
• Obstetric Labor Complications
• Odds Ratio
• Parity
• Pennsylvania
• Pregnancy
• Retrospective Studies
• Trial of Labor
• surgery
• hsrmtgs

UI: 103624237

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