Neuraxial Analgesia in Pregnant Hispanic Women: An Assessment of Their Beliefs and Expectations

Gender roles as predictive factors on labor pain: a cross-sectional study

Labor is a complex, subjective experience, and all factors that influence pain should be considered to ensure a comprehensive evaluation. This study aimed to determine whether gender roles were predictive of labor pain. The study has a descriptive and cross-sectional design. It was carried out in a delivery room of a city hospital in Turkey between September 2019 and September 2020. The study sample consisted of 231 primiparous women presenting for labor and delivery. Data were gathered with a descriptive characteristics form, Visual Analogue Scale and The Bem Sex-Role Inventory. Descriptive statistics and simple regression analysis were employed to analyze the obtained data. Regression analysis demonstrated that gender roles were predictive of labor pain in the latent, active, and transitional stages, but not in the second stage. Gender roles were most responsible for labor pain in the latent phase. Results of the study revealed that gender roles may be useful variables to predict women's labor pain, and contributed to the relevant literature. Nurses and midwives offering care for labor pain should consider gender roles as a factor affecting labor pain. It is also necessary to individualize the supporting care given during labor.

Racial and Ethnic Patient Care Disparities in Anesthesiology: History, Current State, and a Way Forward

Disparities in patient care and outcomes are well-documented in medicine but have received comparatively less attention in anesthesiology. Those disparities linked to racial and ethnic identity are pervasive, with compelling evidence in operative anesthesiology, obstetric anesthesiology, pain medicine, and critical care. This narrative review presents an overview of disparities in perioperative patient care that is grounded in historical context followed by potential solutions for mitigating disparities and inequities.

Racial and Ethnic Differences in the Receipt of Regional Anesthesia Among Patients Undergoing Thoracic Surgery

OBJECTIVES

The objective of this study was to assess differences in the use of perioperative regional anesthesia for thoracic surgery based on race and ethnicity.

DESIGN

This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program from 2015 to 2020. The study authors applied a multivariate logistic regression in which the dependent variable was the primary endpoint (regional versus no regional anesthesia). The primary independent variables were race and ethnicity.

SETTING

Multiple healthcare systems in the United States.

PARTICIPANTS

Participants were ≥18 years of age and undergoing thoracic surgery.

INTERVENTIONS

Regional anesthesia.

MEASUREMENTS AND MAIN RESULTS

On adjusted multivariate analysis, Hispanic patients had lower odds (odds ratio [OR] 0.61, 95% CI 0.46-0.80, p = 0.0003) of receiving regional anesthesia for postoperative pain control compared to non-Hispanic patients. There was no significant difference in the odds of regional anesthesia when comparing racial cohorts (ie, White, Black, Asian, or other).

CONCLUSIONS

There were differences observed in the provision of regional anesthesia for thoracic surgery among ethnic groups. Although the results of this study should not be taken as evidence for healthcare disparities, it could be used to support hypotheses for future studies that aim to investigate causes of disparities and corresponding patient outcomes.

Women's sense of control during labour and birth with epidural analgesia: A qualitative descriptive study

BACKGROUND

Sense of control during childbirth is a critical issue concerning the association between high-quality maternity care and infant health. This study explored the facilitators of or barriers to a sense of control and the need for interventions to raise women's experience in childbirth.

METHODS

The data came from 17 participants. Data collection was conducted in the childbirth room and within three days following childbirth, respectively. For tackling the research problems, participant observation and interviewing were applied. Thematic analysis was applied to the data analyzed.

RESULTS

Two themes were identified: (1) facilitators of or barriers to practice a sense of control and (2) Care needed for a sense of control. The effectiveness of a sense of control is related to energy refill, mental loading subsided, control over decisions, non-pharmacological usage, and support from the meaningful person. Care needed includes showing empathy, providing information, using complementary pain-relief strategies, and adjusting care by parturient conditions.

CONCLUSION

This study highlights the influencing factors and interventions relating to women's sense of control during childbirth with epidural analgesia. The findings suggest that many approaches, such as white noise, benefit women's sense of control after an epidural. Using non-pharmacological methods, such as a birth ball, should be appropriately regulated by situations to enhance women's sense of control. Through the assessment, education, attention to maternal needs, and recognizing the barriers to a sense of control, women will benefit from the interventions designed to improve their sense of control during childbirth.

An Update on Racial and Ethnic Differences in Neuraxial Anesthesia for Cesarean Delivery

Background Racial and ethnic differences in the use of neuraxial anesthesia compared with general anesthesia are less studied, particularly in obstetrical anesthesia. Here, we aimed to provide an update on the association between race and ethnicity, and the use of neuraxial anesthesia for cesarean delivery in the United States (US). Methods We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File 2019. We extracted cases that had a primary surgery defined with Current Procedural Terminology (CPT) code for cesarean delivery (59510, 59514, and 59515) and cesarean after attempted vaginal delivery in parturients with a prior history of cesarean (59618, 59620, and 59622). Multivariable logistic regression was used to report the association of race and ethnicity with primary anesthetic technique. Results There were 12,876 parturients included in the study. Compared with White parturients, Black (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI): 0.57-0.88, p = 0.001) and American Indian or Alaska Native (aOR = 0.22, 95% CI: 0.12-0.40, p < 0.001) parturients had lower odds of receiving neuraxial compared with general anesthesia. There were no significant differences in the odds of neuraxial anesthesia between non-Hispanic and Hispanic cohorts. Conclusions While we do observe racial differences in anesthetic technique, Hispanic patients did not have significantly lower odds of neuraxial anesthesia. This study highlights the importance of an update to prior studies, as the current study suggests a lack of disparity between non-Hispanic and Hispanic parturients. While the results here are encouraging, a multidisciplinary approach is necessary to further address racial disparities.