Study: Spanish-speaking Hispanic women less likely to use neuraxial analgesia during labor

Why do Hispanic women have reduced rates of epidural or spinal (neuraxial) analgesia during labor? Language barriers may be a key factor, according to a study in Anesthesia & Analgesia.

Women whose primary language is Spanish are less likely to plan and receive neuraxial analgesia during labor, compared to Hispanic women who speak English, report Dr. Paloma Toledo and colleagues of Northwestern University Feinberg School of Medicine, Chicago. They conclude, "Because Spanish-speaking Hispanic women were less likely to anticipate and use neuraxial labor analgesia, it is possible that language may be a barrier to effective counseling on and understanding of analgesic options."

Language Contributes to Disparities in Pain Control during Labor
The study included 932 Hispanic women with vaginal delivery of their first baby between 2007 and 2010. The primary language was Spanish for 19.5 percent of the women; the rest spoke English.

Rates of anticipated (planned) and actual neuraxial analgesia use were compared for Spanish-speaking versus English-speaking women. Other factors potentially affecting labor analgesia—including demographic and delivery-related factors—were assessed as well. All women in the study were Medicaid beneficiaries.

Even though the two language groups had similar characteristics, they differed in their use of labor analgesia. Epidural analgesia was anticipated by 30 percent of the Hispanic women whose primary language was Spanish, compared to 42 percent of those who spoke English. The Spanish-speaking women were also less likely to actually use neuraxial analgesia: 66 versus 75 percent.

The differences remained significant after adjustment for other factors. Spanish-speaking women were 30 percent less likely to plan for neuraxial analgesia and 12 percent less likely to actually receive it, relative to English-speaking Hispanic women. Once labor started, the two groups had similar rates of deciding to use analgesia.

Women whose delivery was performed by a midwife also had lower rates of labor analgesia, regardless of language. Anticipated neuraxial analgesia use was about one-third lower for women whose provider was a midwife (versus an obstetrician), while actual use of analgesia was one-half lower. Women younger than 20 also had a lower rate of anticipated analgesia, although actual analgesia use was similar by age.

Studies have shown that minority women are less likely to receive neuraxial analgesia for labor, with Hispanic women having the lowest rate. The reasons for this disparity are unclear, but some evidence suggests that Hispanic women have "significant misunderstanding" about labor analgesia—for example, that it will lead to chronic back pain or paralysis. The issue is important, as nearly one-fourth of deliveries in the United States are to women of Hispanic ethnicity.

The new findings suggest a "language-based disparity" in planning for and using neuraxial analgesia during labor among Hispanic women. "Spanish as a first language may create a communication barrier for receipt of neuraxial labor analgesia," Dr. Toledo and colleagues write.

More research will be needed to determine whether Hispanic women receive information on labor analgesia in their primary or preferred language, and whether there are similar barriers with other languages. The researchers note that all of the women were offered counseling on labor analgesia, and that interpreters were available 24 hours a day

They also call attention to the lower rate of labor analgesia among women who use a midwife for delivery. This may reflect negative attitudes toward neuraxial analgesia among midwives, which might have a greater impact on decision making for women with limited English proficiency.

Dr. Toledo and coauthors call for further research on how language barriers affect informed decisions about labor analgesia for Hispanic women. They conclude, "Evaluation of the systems in place to facilitate adequate education and communication should be evaluated, in order to provide safe, high-quality care for Hispanic patients."