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

• Research suggests that women of color may lack access to epidurals in labor.
• We find that women of color were less likely than white women to plan epidurals.
• Women of color were more likely to experience pressure to have epidurals.
• They were also more likely to experience anesthesia failure and to have it ignored.
• We challenge the focus on access and suggest an alternative theory for research.

ObjectiveA 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.MethodsWe 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.ResultsAmong 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.ConclusionOverall 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.