Newly Published
Perioperative Medicine  |   July 2019
Education Program Regarding Labor Epidurals Increases Utilization by Hispanic Medicaid Beneficiaries: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon (B.M.T., L.M.N., M.M.T.); the Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico (K.M.S.); the Memorial Hospital (Beacon Health System), South Bend, Indiana (M.K.W.); and the School of Public Health, Oregon Health and Science University and Portland State University, Portland Oregon (N.D.Y., M.M.T.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication October 25, 2018. Accepted for publication May 29, 2019.
    Submitted for publication October 25, 2018. Accepted for publication May 29, 2019.×
  • Correspondence: Address correspondence to Dr. Togioka: Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code UHS-2, Portland, Oregon 97239. togioka@ohsu.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia
Perioperative Medicine   |   July 2019
Education Program Regarding Labor Epidurals Increases Utilization by Hispanic Medicaid Beneficiaries: A Randomized Controlled Trial
Anesthesiology Newly Published on July 8, 2019. doi:10.1097/ALN.0000000000002868
Anesthesiology Newly Published on July 8, 2019. doi:10.1097/ALN.0000000000002868
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Hispanic women choose epidural labor analgesia less commonly than non-Hispanic women. The causes of the healthcare disparity are unknown, and effective interventions are to be established.

What This Article Tells Us That Is New:

  • A language-concordant, educational program regarding labor epidurals during the first stage of labor, in addition to the routine prenatal education, is feasible and does not cause any negative effect.

  • Such an intervention increases epidural use among Hispanic but not non-Hispanic women.

  • It also reduces misconceptions regarding epidural analgesia in both Hispanic and non-Hispanic women.

Background: Hispanic women choose epidural labor analgesia less commonly than non-Hispanic women. This may represent a healthcare disparity related to a language barrier and inadequate opportunities for labor analgesia education. It was hypothesized that a language-concordant, educational program regarding labor epidurals would improve epidural utilization in two independent cohorts of Hispanic and non-Hispanic women.

Methods: A randomized controlled trial, blinded to anesthesia, nursing, and obstetric providers, was completed at an academic hospital (February 2015 to February 2017). Two cohorts of Medicaid beneficiaries of Hispanic (English- and/or Spanish-speaking) and non-Hispanic ethnicity were enrolled concurrently. The patients were randomized to routine care alone or routine care and an additional educational program comprised of three components: a video show, corresponding pamphlet, and in-person counseling. The primary endpoint was use of epidural labor analgesia. The secondary endpoint was change in response before and after delivery on common misconceptions based on a 12-point epidural questionnaire.

Results: Hispanic women randomized to the intervention group were 33% more likely to choose epidural analgesia compared to the routine care group (40 of 50 [80%] vs. 30 of 50 [60%]; risk ratio, 1.33 [95% CI, 1.02 to 1.74]; P = 0.029). For the non-Hispanic cohort, no difference was detected in epidural use between the intervention and routine care groups (41 of 50 [82%] vs. 42 of 49 [86%]; risk ratio, 0.96 [95% CI, 0.80 to 1.14]; P = 0.62), but the study was underpowered to determine a result of no difference. Patients assigned to the intervention had a greater improvement in epidural understanding compared with routine care, among both Hispanic (2.26 vs. 0.74, respectively; difference in change from baseline, 1.52 [95% CI, 0.77 to 2.27]; P < 0.001) and non-Hispanic (1.36 vs. 0.33, respectively; difference in change from baseline, 1.03 [95% CI, 0.23 to 1.75]; P = 0.005) cohorts. There were no adverse events during the trial.

Conclusions: The educational program increased epidural use among Hispanic women. The educational program reduced misconceptions regarding epidural analgesia in both Hispanic and non-Hispanic cohorts.