Hispanic women were 53% less likely to have an epidural during childbirth and 41% less likely to use a combination of epidural and IV medications for labor pain relief than women in all other racial groups, new research found.
According to a 2011 CDC report analyzing singleton births in 27 states in 2008, 61% of women used an epidural during vaginal births. Reports on epidural rates range from 47% to 76% of vaginal births, while between 39% and 56% of women use narcotic analgesics via IV for managing labor and delivery pain.
However, new research conducted by Juliane Milburn, RN, PhD, FNP, as a University of Virginia School of Nursing doctoral candidate showed Hispanic women were an exception to national trends.
One of the most unique features of childbirth pain is that it is one of the few situations in healthcare where acute pain may be left untreated as part of care management, Milburn said in a news release. And for some women, the ability to make that choice is more important than medical interventions.
For her research, Milburn examined more than 7,000 medical records from a six-year period in the University of Virginia Medical Center archives and found some unusual patterns in pain relief for childbirth by race. Her dissertation qualified and quantified why so many Hispanic women opt out of pain relief during childbirth when compared to women of other races.
She found of all the women who gave birth at the medical center during those six years, slightly more than 16% chose no pharmacologic method of pain control during labor. Nearly 43% opted for IV drugs to relieve childbirth pain, and nearly 71% chose a spinal epidural during childbirth. Of the women who used pharmacologic pain relief, nearly 30% chose both IV drugs and an epidural.
By comparison, Milburn found 22.4% of Hispanic women opted for no pain relief during childbirth at all, compared with 14% for all other races. Nearly 45% of Hispanic women refused an epidural, compared with 26% of women from all other races, her findings showed.
In all pain-control method categories, Asians, African-Americans and whites made similar choices, with the exception that Asians used epidurals with greater frequency than other groups.
The Hispanic and Latino population in the U.S. grew by 43% in a decade, according to the 2010 Census, making it the nations largest minority group. With such large growth, Milburn said its critical for nurses to learn that in some cultures, pain during childbirth is viewed as a necessary and natural rite of passage for which no relief is sought.
A womans experience during the childbirth and hospitalization can shape future healthcare practices for the entire family, and a significant facet of that experience is pain control, making the nurses understanding of birthing practices and pain management for this population crucial, she said in the release.
For her research, Milburn conducted 17 interviews with a group of Hispanic mothers nationwide within two years of giving birth. She learned the determination to give birth medication-free was based on a number of culturally based belief systems, including ideal birth standards, religion, their mothers and grandmothers stories, and misconceptions about possible side-effects drugs might have on their infants and themselves.
The interviews revealed a number of themes about Hispanic womens beliefs about childbirth, including:
Labor and childbirth are battles to be overcome;
The pain of that battle is an integral part of the process, as well as something that is better for babies;
A mothers role is akin to the Virgin Marys, one of sacrifice and denying ones own needs for those of the child;
Enduring the pain of labor, and being strong throughout the process is valued by the culture;
A pervasive belief that epidurals will cause permanent back problems.
Julianes interest in this topic came out of her own clinical practice of working in labor and delivery caring for such women, her travels to Spanish-speaking countries, fluency in Spanish and also as a labor and delivery nurse in a local primary care clinic for migrants, Milburns adviser, Linda Bullock, RN, PhD, FAAN, associate dean for research in the nursing school, said in the release. Her research fills a real gap in our understanding of why these patterns in pain relief exist. Nurses, being there at the bedside, are patients best advocate and often serve as primary navigators during their hospital stay, so understanding certain groups propensities to have (or refuse) pain relief is part of culturally competent care.
Past research has framed the lower epidural rate among Hispanic women as a disparity, but it might instead be a lack of cultural understanding, Milburn said.
For nurses, the ability to understand the cultural beliefs and practices of ethnic and racial minorities and immigrant women regarding the birth process would help to improve the overall health of the mother and her family, she said in the release. It can also assist in alleviating the stress of unfamiliarity during a critical time in a womans life. With Hispanics now the largest minority group in the U.S., attention to their culture and healthcare needs is needed to prevent further disparities.