Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX 77026, USA.
J Immigr Minor Health. 2012 Apr;14(2):287-91. doi: 10.1007/s10903-011-9440-2.
Ethnic disparities in labor pain management exist. Our purpose is to identify patients' attitudes and beliefs about epidural analgesia in order to develop a culturally competent educational intervention. A prospective observational study was conducted in patients admitted for vaginal delivery between July 1st-31st, 2009. Inclusion criteria were: singleton, term, cephalic, normal fetal heart tracing and no contraindications for epidural. Patients were surveyed regarding their wishes for analgesia, and their reasons for declining epidural. The obstetrics physician performed pain management counseling as is usually done. Patients were asked again about their choice for analgesia. Likert scale questionnaires were used. Wilcoxon signed ranked test was used for categorical variables. Logistic regression was performed to look for predictors of epidural request. Fifty patients were interviewed. Average age was (27.9 ± 6.7), gestational age (39.3 ± 1.3), and a median parity of 2 (range 0-6). 72% declined epidural upon admission, and 61% after counseling (P = 0.14). Most common reasons for declined epidural were 'women should cope with labor pain' (57%), 'fear of back pain' (54%) and 'family/friends advise against epidural' (36%). Acculturation was assessed by years living in the US (10 ± 6.3), preferred language (Spanish 80%) and ethnic self-identification (Hispanic 98%). 38% were high school graduates. In multivariate logistic regression, graduation from high school was the only variable associated to request for epidural in labor (OR 4.94, 95% CI 1.6-15.1). Educational level is associated to requesting an epidural in labor. Knowledge of patients' fears and expectations is essential to develop adequate counseling interventions.
种族间在分娩疼痛管理上存在差异。我们的目的是确定患者对硬膜外镇痛的态度和信念，以便制定一种文化上合适的教育干预措施。在 2009 年 7 月 1 日至 31 日期间，对因阴道分娩而住院的患者进行了前瞻性观察研究。纳入标准为：单胎、足月、头位、正常胎儿心音，且无硬膜外禁忌证。对患者的镇痛意愿及其拒绝硬膜外的原因进行了调查。产科医生按照常规进行疼痛管理咨询。再次询问患者对镇痛的选择。使用李克特量表问卷。对分类变量使用 Wilcoxon 符号秩检验。使用逻辑回归来寻找硬膜外需求的预测因素。共采访了 50 名患者。平均年龄为（27.9 ± 6.7）岁，孕龄（39.3 ± 1.3）周，中位数产次为 2（范围 0-6）。入院时 72%的患者拒绝硬膜外，咨询后 61%的患者拒绝（P = 0.14）。拒绝硬膜外的最常见原因是“女性应该忍受分娩疼痛”（57%）、“害怕背痛”（54%）和“家人/朋友建议不要使用硬膜外”（36%）。通过在美国居住的年数（10 ± 6.3）、首选语言（西班牙语 80%）和自我认同的种族（西班牙裔 98%）来评估文化适应程度。38%的患者为高中毕业生。在多变量逻辑回归中，高中毕业后是请求硬膜外分娩的唯一相关变量（OR 4.94，95%CI 1.6-15.1）。教育水平与请求硬膜外分娩有关。了解患者的恐惧和期望对于制定适当的咨询干预措施至关重要。
