Epidural analgesia during labor among immigrant women in Sweden

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Abstract
Objective. To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Design. Population‐based register study. Setting. Nationwide study in Sweden. Population. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37–41 completed gestational weeks during 1992–2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Methods. Register study with perinatal data from the Medical Birth Register and socio‐demographic variables from national income and population registers. Main outcome measure. Use of EDA during vaginal delivery. Results. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23–1.57); Iran, OR 1.38 (1.26–1.53); Poland, OR 1.22 (1.08–1.37) and Finland, OR 1.10 (1.03–1.17) after adjustments for perinatal and socio‐demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46–0.70); Iraq, OR 0.71 (0.64–0.78); Turkey, OR 0.77(0.69–0.86) and Yugoslavia, OR 0.85 (0.79–0.91). Having a native Swedish partner increased the use of EDA in immigrant women. Conclusion. EDA use during labor varies more by maternal country of origin than by socio‐economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.

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