Use of neuraxial analgesia for labor varies across US states, but the causes underlying those variations are unclear, according to a population-based cross-sectional analysis published in JAMA Network Open.
Publicly available and deidentified data from US birth certificates for the year 2015 were analyzed retrospectively (n=2,625,950). The main outcomes for the analysis were state-specific prevalence of neuraxial analgesia per 100 women who gave birth and variation in the use of neuraxial analgesia among states — assessed using multivariable regression analysis. Among the parameters assessed were maternal age, race/ethnicity, insurance type, highest level of education, marital status, body mass index at delivery, previous cesarean delivery, gestational age at delivery, and labor induction.
Medicaid and private insurance covered >90% of women in the cohort. The majority of women (73.1%) were given neuraxial analgesia during labor. The states of Maine and Nevada had the lowest and highest prevalence of neuraxial analgesia use, respectively, after adjusting for antepartum, obstetric, and intrapartum factors (Maine: 36.6%; 95% CI, 33.2%-40.1%; Nevada: 80.1%; 95% CI, 78.3%-81.7%). The median odds ratios was 1.5 in the null model (95% CI, 1.4-1.6), suggesting that the odds of women receiving neuraxial analgesia varied by state, and that moving to a state with a higher rate of neuraxial analgesia would increase the odds for receiving this treatment by 50%.
Limitations of the study include its retrospective nature, the possibility of inaccuracies on birth certificates, and the lack of hospital-level data.
“With American College of Obstetricians and Gynecologists guidelines stating that anesthesia services should be available to provide labor analgesia in all hospitals that provide maternal care, efforts should be made to better understand the main reasons for the variation and whether this variation influences maternal or perinatal outcomes,” noted the study authors.
Butwick AJ, Bentley J, Wong CA, Snowden JM, Sun E, Guo N. United States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open. 2018;1(8):e186567.