Epidural Acceptance Rates by Ethnicity After Introduction of an Epidural Education Sheet

Abstract

Purpose : There is limited but positive evidence that suggests improved, culturally-competent patient counseling regarding the risks and benefits of neuraxial anesthesia during labor can reduce racial inequalities in the use of this safe and effective pain control option. We aim to determine whether the implementation of a standardized educational tool at prenatal visits can further bridge these disparities. Methods: We reviewed twelve months of labor information on patients who delivered at the Cambridge Hospital (CH), Cambridge, MA, from July 1st, 2018 to June 30th, 2019 to determine baseline epidural rates, by race, ethnicity, and primary language of care at our institution. Results: Of 1070 deliveries at the CH from July 2018 to June 2019, 752 (70.3%) were vaginal deliveries. Five races, 64 ethnicities, and 31 primary languages were recorded. For all 752 vaginal deliveries, 490 (65.2%) used epidural anesthesia (EA), 36 (4.8%) used local anesthesia, 8 (1.1%) used nitrous gas, and 218 (29.0%) received no anesthesia. In an analysis by race, 72.1% of Asian patients, 59.2% of Black patients, 64.1% of Hispanic patients, and 64.9% of White patients used EA. In analysis by ethnicity, 83.3% of Nepalese patients, 79.1% of Brazilian patients, 75.0% of Moroccan patients, 65.4% of American patients, 64.3% of African American patients, 63.0% of Haitian patients, and 40.0% of Salvadorian patients used EA. English speaking patients requested EA 65.9% of the time, as compared to 64.6% of Non-English speaking patients. Conclusions: Our study found significant diversity in epidural use by ethnicity in our pre-intervention cohort. Next steps include implementation of the information sheet in the clinics, and tabulation of the change in epidural acceptance rates by race and ethnicity post-intervention at the CH. We anticipate that providing culturally-competent patient information about neuraxial anesthesia in labor may increase acceptance of neuraxial anesthesia by patients.