A study presented at the ANESTHESIOLOGY™ 2012 annual meeting found the role of women’s primary language impacts whether or not they receive an epidural for pain relief during labor. The birth of an infant is the leading cause of hospital admissions in the United States. Births to minorities account for more than half the births in the country, according to the most recent census.
While epidurals are the most effective method for pain management during labor, evidence suggests there are racial and ethnic disparities in the use of them. Past studies have shown Hispanic women have the lowest rates of epidural use. However, these studies have not looked at the difference among these women based on the primary language spoken at home.
“Our study was the first to evaluate disparities among English and Spanish-speaking Hispanic women admitted for delivery of their first infant,” said study author Paloma Toledo, M.D., M.P.H., Department of Anesthesiology and Program for Health Equity, Northwestern University, Feinberg School of Medicine. “We wanted to confirm if language disparities impact whether or not Hispanic women receive an epidural.”
About the Study
The Northwestern University study, funded by the Agency for Healthcare Research and Quality, evaluated electronic medical record data for 1,424 Hispanic women who delivered at a large urban maternity hospital. Statistical methods were adjusted for factors that could influence epidural use including age, insurance status, income and marital status.
Findings showed the use of epidurals was lower for Spanish-speaking Hispanic women than for English-speaking Hispanic women (66 percent vs. 81 percent). Spanish-speaking Hispanic women had as much as a 40 percent lower odds of using an epidural than English-speaking Hispanic women. In addition, 96 percent of all women who requested an epidural received one, suggesting system level issues were not responsible for the lower epidural rate.
“The study is important because it reveals a health care delivery disparity among Hispanic women based on spoken language,” added Dr. Toledo. “These findings, along with future research, will help us identify and target interventions, whether they are at the system, provider or patient level, to better educate Spanish-speaking Hispanic women about their pain relief options during labor.”
The study is one step toward meeting the U.S. Department of Health and Human Services’ Healthy People 2020 goal of eliminating health care disparities that occur by race or ethnicity in the United States.