Race inequality in epidural use and regional anesthesia failure in labor and birth: an examination of women's experience.

OBJECTIVE: A known racial disparity in medical care is that white women receive epidurals more often in labor than do women from other racial and ethnic groups. Medical researchers have framed this disparity as due to some women's lack of access to anesthesia. Further, an unexamined racial disparity in medical care is that anesthesia failure in labor and birth may also have racial disparity. We explore the organizational processes that may lead to racial disparity an epidural use and regional anesthesia failure in labor and birth.
METHODS: We draw on semi-structured, in-depth interviews conducted with 83 women in June through December, 2010 the day after they gave birth at a New England tertiary care hospital.
RESULTS: Among women who did not plan to have an epidural, women of color were more likely to face pressure to accept the epidural by hospital medical staff. Further, among women who received anesthesia (either during vaginal delivery or a C-section), women of color were more likely to experience failure in their pain medication and were less likely to have their pain and anxiety taken seriously by doctors.
CONCLUSION: Overall we challenge the contention that access is the primary way women's epidural experiences are influenced by race and suggest an alternative lens through which to understand racial dynamics and epidural use and anesthesia failure in labor and birth.