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A Prospective Observational Study of Ethnic and Racial Differences in Neuraxial Labor Analgesia Request and Pain Relief

Wilson, Sylvia H. MD*; Elliott, Matthew P. MD*; Wolf, Bethany J. PhD; Hebbar, Latha MD, FRCA*

doi: 10.1213/ANE.0000000000000260
Obstetric Anesthesiology: Research Report

BACKGROUND: As ethnic and racial diversity increases, it is important that anesthesia providers understand the expectations and concerns of this changing population regarding labor analgesia. Our objective was to evaluate ethnic/racial differences in labor analgesia characteristics with regard to the timing of request for neuraxial analgesia.

METHODS: Three hundred ninety-seven parturients were enrolled in this prospective observational cohort study. Term laboring parturients who planned vaginal delivery and requested neuraxial labor analgesia were eligible for inclusion. Data collected included cervical dilation at the time of neuraxial analgesia request, self-identified ethnicity/race, parity, education, insurance status, pain score before and after the initiation of neuraxial analgesia, and mode of delivery. The primary outcome was cervical dilation at the time of neuraxial analgesia request. Ethnicity/race classification was determined by asking the patient, “How would you define your ethnicity?” Patients were categorized into the ethnic/racial groups of non-Hispanic White, African American, Hispanic, or other. Univariate associations between cervical dilation and categorical variables were examined. Multivariate analysis was performed for the primary outcome of cervical dilation at the time of initiation of neuraxial analgesia.

RESULTS: At the time of neuraxial analgesia placement, the mean difference in cervical dilation of Hispanic parturients was 0.8 cm compared to non-Hispanic Whites (95% confidence interval [CI], 0.1–1.4; P = 0.047). After controlling for education, reason for placement, labor augmentation, and mode of delivery in a multivariate model, Hispanic parturients had 0.5 cm greater cervical dilation compared to non-Hispanic Whites, which was not significant (95% confidence interval, −0.1 to 1.1; P = 0.089).

CONCLUSIONS: Our data indicate that ethnicity/race plays a small role in acceptance and request for neuraxial labor analgesia.

Published ahead of print May 22, 2014

From the Departments of *Anesthesia and Perioperative Medicine, and Public Health Service, Medical University of South Carolina, Charleston, South Carolina.

Accepted for publication February 21, 2014.

Published ahead of print May 22, 2014

Funding: Not funded.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the Society for Obstetric Anesthesia and Perinatology annual meeting, 2013.

Reprints will not be available from the authors.

Address correspondence to Sylvia H. Wilson, MD, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301 MSC 912 Charleston, SC 29425-9120. Address e-mail to

© 2014 International Anesthesia Research Society