Use of epidural in childbirth is linked to decreased severe maternal
morbidity
Risk of SMM for racial and ethnic minority women is three times as high
as for non-Hispanic white women

Date:
February 22, 2022
Source:
Columbia University's Mailman School of Public Health
Summary:
In a study of vaginal births in New York State hospitals, labor
neuraxial analgesia -- having an epidural or combined spinal and
epidural -- was associated with a decreased risk of severe maternal
morbidity. Deliveries with a neuraxial analgesic also lessened the
risk of post-partum hemorrhaging, the leading cause of preventable
severe maternal morbidity.

The researchers found that a decreased risk of severe maternal
morbidity associated with neuraxial analgesia was similar between
non-Hispanic White women and racial and ethnic minority women.



FULL STORY ==========================================================================
In a study of vaginal births in New York State hospitals, labor
neuraxial analgesia -- having an epidural or combined spinal and
epidural -- was associated with a decreased risk of severe maternal
morbidity. Deliveries with a neuraxial analgesic also lessened the risk
of post-partum hemorrhaging, the leading cause of preventable severe
maternal morbidity, according to the research conducted at Columbia
University Mailman School of Public Health and Columbia Vagelos College
of Physicians and Surgeons (P&S). The researchers found that a decreased
risk of severe maternal morbidity associated with neuraxial analgesia was similar between non-Hispanic White women and racial and ethnic minority
women. The results are published online in JAMA Network Open.


========================================================================== Labor neuraxial analgesia -- epidural or combined spinal-epidural
analgesia is the most effective technique to alleviate labor pain and is
used in nearly three-quarters of birthing women in the U.S. As of 2021, postpartum hemorrhage (PPH) was the leading cause of preventable severe maternal morbidity (SMM) and overall maternal mortality. SMM in this
study involves 16 maternal complications including heart failure and 5 procedures such as hysterectomy.

"Our goal was to examine the potential benefit of labor
neuraxial analgesia in reducing severe maternal morbidity," said
Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology at
Columbia P&S, and first author. "The findings indicate that use of labor neuraxial analgesia for vaginal deliveries is associated with a 14%
reduction in severe maternal morbidity. Labor neuraxial analgesia may facilitate early evaluation and management of the third stage of labor
to avoid escalation of post-partum hemorrhaging into grave complications
and death." Study results showed that SMM occurred in 7712 women (1.3 percent), of which 2748 (36 percent) had PPH.

Use of neuraxial analgesia for vaginal delivery was associated with
a 14 percent decrease in the risk of severe maternal morbidity. The
reported incidence of SMM has more than doubled between 1999 and 2017, affecting approximately 1 in 60 women in 2017. Of concern, the risk of
SMM is up to a 3- fold increase for racial and ethnic minority women
compared with non-Hispanic White women. Therefore, expanding access to
and utilization of labor neuraxial analgesia may contribute to improving maternal health outcomes.

To assess the association between labor neuraxial analgesia and SMM,
the researchers used data from a large cohort of vaginal deliveries
in New York hospitals. The study sample included hospitalizations for
vaginal delivery among women aged 15 to 49 years between January 2010,
and December 2017. The analysis was limited to New York, as it is the
only Healthcare Cost and Utilization Project participating state also
providing information on anesthesia care.

During the study period there were 575,524 women with vaginal
deliveries. The average age of the women was 28 years, of which 8 percent
were non-Hispanic Asian or Pacific Islander, 15 percent were non-Hispanic Black, 18 percent were Hispanic, 45 percent were non-Hispanic White,
and 13 percent were of other race and ethnicity.

While approximately 80 percent of non-Hispanic white women receive the analgesia nationwide, 70 percent of non-Hispanic Black women and only 65 percent of Hispanic women receive it. Additionally, about 75 percent of pregnant women with health insurance receive labor neuraxial analgesia
but only half of uninsured pregnant women do.

Several intervention programs could help increase access to and
utilization of labor neuraxial analgesia, including prenatal maternal education, Medicaid expansions, and in-house obstetric anesthesia teams
. "These programs may improve patient participation in clinical decision
making and access to care," observed Guohua Li, MD, DrPH, professor of epidemiology and Anesthesiology at Columbia Mailman School and P&S,
and senior author. "Increasing the use of labor neuraxial analgesia
among minority women would help narrow the racial and ethnic gap in the utilization of obstetric anesthesia care, likely leading to improvement
in maternal health equalities." Co-authors are Ruth Landau, Alexander Friedman, and Stanford Chihuri, Columbia University Vagelos College
of Physicians and Surgeons; and Jamie Daw, Columbia Mailman School of
Public Health.

========================================================================== Story Source: Materials provided by Columbia_University's_Mailman_School_of_Public_Health.

Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Jean Guglielminotti, Ruth Landau, Jamie Daw, Alexander M. Friedman,
Stanford Chihuri, Guohua Li. Use of Labor Neuraxial Analgesia for
Vaginal Delivery and Severe Maternal Morbidity. JAMA Network Open,
2022; 5 (2): e220137 DOI: 10.1001/jamanetworkopen.2022.0137 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220222135437.htm

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