Intrapartum Pain Management in Hispanic Women

Abstract
Background and purpose. Current literature on labor pain management highlights a disparity in pain control administration with regard to minority groups, including Hispanics, as compared with Caucasian women, with particular attention on epidural anesthesia (Atherton, Feeg, & El-Adham, 2004). However, cultural practices have an enormous influence on the health behaviors of the Hispanic community, prompting the question of whether this difference is a disparity or a woman’s choice. The purpose of this study was to understand Hispanic women’s use or non-use of pain medication or anesthesia during labor and to shed light on health disparities identified in the literature.
Methods. A mixed methods approach was used to reinforce the strengths as well as address the weaknesses within the respective methods used. A secondary data analysis was conducted with six years of data on inpatient intrapartum admissions from the Clinical Data Repository (CDR) at the University of Virginia (UVa) Health System. Individual interviews with a convenience sample of Hispanic women, less than 2 years postpartum, from a prenatal education class in Winchester, VA were conducted, to provide context to the secondary data analysis.
Findings. Findings from the quantitative analysis show a significant difference in the use of childbirth pain management methods based on race, age, and insurance provider. Hispanic women were 53% less likely than all other races to use regional analgesia (epidural), and 41% less likely to use a combination of epidural and intravenous (IV) medication during labor. In addition, women under 30 years of age, for all races, were more likely to use epidurals or a combination of epidurals and IV medications than no pharmacologic method, while women who were self-pay were less likely to use these methods. Findings from the qualitative analysis revealed four main themes: 1) pain: a childbirth rite of passage; 2) bravery shapes personal agency; 3) cultural mystery; and 4) communicating quality care.
Discussion. The findings from the quantitative phase of this study are supported by the results from the qualitative interviews with Hispanic women. The interview participants spoke of the desire for an ideal birth experience with little medical intervention, and all spoke of a fear that epidural anesthesia would cause permanent back pain or problems. The qualitative findings shed light on possible reasons why Hispanic women used epidurals less often than other races. Additional findings were that the women spoke of misconceptions about the safety and efficacy of pharmacologic pain control methods, as well as communication barriers between themselves and health care providers.
Conclusions. The racial differences in epidural use during childbirth does not appear to be a health disparity, but a choice made by Hispanic women. Overall findings from this study demonstrate a need for the use of shared decision-making strategies for childbirth pain management in the intrapartum setting, and development of a decision-making tool that can be used in this setting