Factors associated with the use of intrapartum epidural analgesia.

Abstract

To evaluate the influence of socioeconomic factors and provider characteristics on the use of intrapartum epidural anesthesia. A total of 8229 deliveries at five hospitals were reviewed retrospectively. Bivariate analysis was performed to identify potential biases in epidural use. Logistic regression was performed to control for confounding variables. Epidural use was predominantly related to parity, with nulliparous women more likely to use an epidural during labor. In hospitals where epidurals were used in a higher percentage of women, we found an association between the woman's insurance status and the specialty of the physician managing labor. Race also appeared to be associated with epidural use in the participating hospital that had a large non-white population. Use of intrapartum epidural analgesia varies considerably among sites and is associated with nulliparity, higher maternal age, and several nonclinical factors.