Effect of ethnicity and parity on utilisation of labour epidural analgesia: a retrospective study

Abstract

Introduction: Disparities in obstetric care in Aotearoa, New Zealand, significantly impact Māori and Pacific women, resulting in higher rates of maternal and neonatal morbidity and mortality. This study investigated the relationship between ethnicity and utilisation of epidural analgesia at our hospital to identify disparities in its provision and inform future research into the contributing factors. Methods: This population-based retrospective cohort study included all deliveries at Christchurch Hospital, Christchurch, Aotearoa New Zealand, over a 4-year period. We performed separate univariable and multivariable logistic regression analyses for primiparous and multiparous women to examine how ethnicity, maternal characteristics and obstetric factors affect epidural utilisation. Results: The study included 22,970 deliveries, with an overall epidural rate for vaginal deliveries of 23.1% (n = 3449). The rate was lower among Māori (18.4%) and Pacific (9.9%) women. There was no significant difference in epidural utilisation between Māori and European women during their first birth (OR 0.87, 95%CI 0.70–1.04, p = 0.12). However, Māori women were less likely to receive an epidural in subsequent births (OR 0.75, 95%CI 0.60–0.92, p < 0.01). Pacific women showed significantly lower epidural rates compared with European women across both parity groups (primiparous OR 0.61, 95%CI 0.44–0.84, p < 0.01 and multiparous OR 0.18, 95%CI 0.09–0.31, p < 0.01), even after controlling for confounders. Discussion: This study outlines the disparities in the utilisation of epidural analgesia at our hospital across various patient demographics. It highlights the need for further qualitative research investigating potential barriers to equitable access to effective labour pain management.