Race, ethnicity, and insurance as determinants of epidural use: Analysis of a national sample survey

The impact of racial, ethnic, and insurance coverage as determinants of epidural use for childbirth pain management was analyzed from a large national dataset of over 2,355 women who delivered single or multiple births. Women reporting publicly funded insurance (Medicaid) were almost twice as likely not to receive an epidural procedure compared to women with private insurance or not insured. Race was not a significant risk factor for nonreceipt of epidural procedures during childbirth; however, ethnicity was strongly associated with nonuse of epidural procedures during normal vaginal deliveries. Hispanic women were twice as likely as non-Hispanic women not to receive an epidural procedure during childbirth. Ethnicity and insurance were observed as significant determinants of epidural use for singleton, normal vaginal deliveries. The ultimate decision related to epidural use may come from mothers' decisions based on cultural expectations or physicians' choice related to clinical or economic reasons.