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Molly Altman, MN, CNM

Predictors of epidural and spinal anesthesia use: A population-based analysis of Washington State, 2003-2004. Molly Altman, MN, CNM. Background. Approximately 50% of laboring women use an epidural or spinal during labor for pain relief

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Molly Altman, MN, CNM

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  1. Predictors of epidural and spinal anesthesia use: A population-based analysis of Washington State, 2003-2004. Molly Altman, MN, CNM

  2. Background • Approximately 50% of laboring women use an epidural or spinal during labor for pain relief • Disparities in epidural use found across maternal age, parity, race/ethnicity, and insurance status • Little data on disparities by hospital level, ownership, or teaching status.

  3. Research Aims The specific aim of the study was to: • Examine the likelihood of epidural use when compared to perinatal level of hospital, ownership of hospital, and teaching status Secondary aims: • Subpopulations • Low-risk women • Spontaneous vaginal deliveries • Low-risk women who had spontaneous vaginal deliveries

  4. Research Design & Methods • Study design • Case control study using Washington State birth certificate data linked to the Comprehensive Hospital Abstract Reporting System (CHARS) • Study population • All women who present in labor with a singleton, term, cephalic-presenting pregnancy, and had a live birth between 2003-2004 • Cases • Women who received an epidural or spinal in labor • Controls • Women who did not receive an epidural or spinal in labor

  5. Research Design & Methods • Exposures of interest • Level of perinatal unit of hospital • Primary, secondary, tertiary • Ownership of hospital • Public non-federal, private non-profit, private religious, private for-profit, military • Teaching status of hospital • Yes, no • Outcome of interest • Epidural and/or spinal anesthesia use during labor

  6. Results Distribution by hospital in Washington State Hospital Median rate of epidural use: 56%, 68 total hospitals included

  7. Characteristics of women who did and did not receive epidural analgesia during labor in Washington State, 2003.

  8. Associations between epidural use and predictors of interest, by subpopulation.

  9. Conclusions • There is significantly higher risk of epidural use in tertiary and secondary level obstetric units than primary level units. • This risk persists when low-risk women and women with spontaneous vaginal deliveries are examined. • More research is needed to determine if these differences in use are due to differential access, availability, or other hospital-level factors.

  10. Thanks! • Many thanks to: • Melissa Schiff, MD (chair) • Mona Lydon-Rochelle, CNM, PhD (committee) • Cathy Wasserman (Washington DOH) • Bill O’Brien (birth certificate guru) • This work was funded by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (Title V, Social Security Act), grant #T76MC00011-21-00.

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