Socially Disadvantaged Women Received Fewer Epidurals for Pain Relief During Childbirth Interview with:
Dr Lucy Halliday
School of Medicine, Dentistry and Nursing
University of Glasgow
Glasgow, UK

pregnancy-woman-belly-hands-46207 (1) What is the background for this study?

Response: Socioeconomic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia is the gold standard for labour analgesia, and is associated with improved maternal pain scores and satisfaction, reduced rates of post-traumatic stress disorder and postnatal depression and may reduce severe maternal morbidity. Scotland is a country with a fully publicly funded national health service that aims to provide equitable treatment that is free at the point of care. We wanted to look at the association between socioeconomic deprivation and utilisation of labour epidural analgesia. What are the main findings?

Response:  We used data from all births in Scotland over a 13-year period, excluding those undergoing elective caesareans section (593,230 women). Socio-economic status deciles (groups of 10% from richest to poorest) were defined using the Scottish Index of Multiple Deprivation.

Women in the most disadvantaged decile were 16% less likely to receive labour epidural analgesia than those in the most advantaged decile, and for every decile increase in level of socioeconomic advantage, women were on average 2% more likely to receive an epidural in labour. This relationship persisted even in the subset of women who had a medical condition for which epidural analgesia may be recommended for maternal safety, and was even more pronounced in women of non-white ethnicity.

Increasing socio-economic disadvantage was also associated with a stepwise increase in a range of adverse maternal characteristics known to be causally related to poor perinatal outcomes including maternal body mass index, comorbidities, smoking and illicit drug use. What should readers take away from your report?

Response: Socio-economic deprivation is associated with lower utilisation of labour epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial. What recommendations do you have for future research as a results of this study?

Response: Future research should focus on the determining the reasons why women chose to use labour epidural analgesia or not. This can help us identify any potential barriers to providing the best possible maternal care, and achieve true patient-centred multidisciplinary decision making.

Any disclosures? No disclosures. Thank you for your interest in our study.

Anaesthesia 2024 Halliday et al. | Socio-economic status and labour epidural analgesia

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Last Updated on February 16, 2024 by