Refusal of Epidural Anesthesia for Labor Pain Management by African American Parturients: An Examination of Factors.

Most parturients use epidural anesthesia for labor pain management, with excellent pain relief possible within minutes of administration. An examination of the literature revealed a disparity of use that existed along ethnic and racial lines, with African Americans less likely to accept epidural anesthesia. No known studies to date had explored the reasons for this disparity. The purpose of this qualitative study was to identify those factors that influence African American parturients to decline epidural anesthesia for labor pain management. Andersen's Behavioral Model of Health Services Use served as the conceptual framework for the study. Twelve primiparous African American parturients were selected for participation through the use of purposive (homogeneous) sampling. Semistructured interviews consisting of closed-ended and open-ended questions were used for data collection. Data analysis involved open coding, core category identification, selective coding, and theme identification. The study revealed 3 themes that helped address the research question: fear, naturalism, and family influence. In nurse anesthesia practice, a thorough understanding of those factors examined in this study may better enable healthcare providers to assist African American parturients in the decision-making process, with the potential for increased patient satisfaction and improved quality of life. Copyright© by the American Association of Nurse Anesthetists.