How Race and Socioeconomic Status Affect Epidural Use in Pregnant Women

Pregnant women facing less socioeconomic opportunity experience lower use of epidurals, particularly Black women, according to a study published online Feb. 1 in Obstetrics & Gynecology.

Jean Guglielminotti, M.D., Ph.D., from Columbia University Vagelos College of Physicians and Surgeons in New York City, and colleagues examined the association between structural racism and labor neuraxial analgesia use. The analysis included data from 1.7 million birth certificates from 2017 (22.8 percent for Black women). A structural racism index was calculated by the county of the delivery hospital as the mean of three Black–White inequity ratios (ratios for lower education, unemployment, and incarceration in jails).

According to a 2014 study in Sexual & Reproductive Healthcare, only 63 percent of Black American women receive epidurals in pregnancy, compared to 74 percent of white women.

The researchers found that the labor neuraxial analgesia rate was 77.2 percent for Black women in the first tercile of the racism index, 74.7 percent in the second tercile, and 72.4 percent in the third tercile, while the rates were 80.4, 78.2, and 78.2 percent, respectively, for White women. For Black women, the second and third tercile were associated with decreased adjusted odds of receiving neuraxial analgesia (18.4 and 28.3 percent, respectively) compared with the first tercile of the racism index. For White women, the decreases were 13.4 and 15.6 percent in the second and third tercile, respectively. There was a significant difference in the odds of neuraxial analgesia between Black and White women for the second and third terciles.

“Social inequity and racism could be significant contributors to racial and ethnic disparities in labor neuraxial analgesia use,” Guglielminotti said in a statement. “Racism — including structural, institutional, and interpersonal racism — is suggested as a root cause of racial and ethnic disparities in perinatal care access and utilization in the United States.”

One author disclosed ties to the bioscience industry.

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