Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008.

OBJECTIVES

This report presents 2008 data on receipt of epidural and spinal anesthesia as collected on the 2003 U.S. Standard Certificate of Live Birth. The purpose of this report is to describe the characteristics of women giving birth and the circumstances of births in which epidural or spinal anesthesia is used to relieve the pain of labor for vaginal deliveries.

METHODS

Descriptive statistics are presented on births occurring in 2008 to residents of 27 states that had implemented the 2003 U.S. Standard Certificate of Live Birth as of January 1, 2008. Analyses are limited to singleton births in vaginal deliveries that occurred in the 27-state reporting area only and are not generalizable to the United States as a whole.

RESULTS

Overall, 61 percent of women who had a singleton birth in a vaginal delivery in the 27 states in 2008 received epidural or spinal anesthesia; non-Hispanic white women received epidural or spinal anesthesia more often (69 percent) than other racial groups. Among Hispanic origin groups, Puerto Rican women were most likely to receive epidural or spinal anesthesia (68 percent). Levels of treatment with epidural or spinal anesthesia decreased by advancing age of mother. Levels increased with increasing maternal educational attainment. Early initiation of prenatal care increased the likelihood of epidural or spinal anesthesia receipt, as did attendance at birth by a physician. Use of epidural or spinal anesthesia was more common in vaginal deliveries assisted by forceps (84 percent) or vacuum extraction (77 percent) than in spontaneous vaginal deliveries (60 percent). Use of epidural or spinal anesthesia was less likely when infants were born prior to 34 weeks of gestation or weighed less than 1,500 grams. Women with chronic and gestational diabetes were more likely to receive an epidural or spinal anesthesia than women with no pregnancy risk factors. Precipitous labor (less than 3 hours) was associated with decreased epidural or spinal anesthesia receipt. longer second stage of labor, and fetal distress (compared with women who receive opiates intravenously or by injection) (1,5,6). Severe headache, maternal hypotension, maternal fever, and urinary retention have also been associated with epidural/spinal anesthesia receipt (5). This report examines the relationship between epidural/spinal anesthesia receipt and selected characteristics of the mother and of labor among vaginal deliveries in the 27-state reporting area as reported on the 2003 U.S. Standard Certificate of Live Birth.