title: Epidural analgesia for labor pain: whose choice?
abstract: OBJECTIVE
  To test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  All delivery units in Sweden.
  
  
  METHODS
  A nationwide sample of 2,529 women.
  
  
  METHODS
  Data were collected by questionnaires in early pregnancy and two months after birth, and from the Swedish Medical Birth Register. Logistic regression analysis was conducted, adjusted for gestational age, induction of labor and infant birthweight.
  
  
  METHODS
  Epidural analgesia during labor.
  
  
  RESULTS
  The odds of having an epidural analgesia were more than twice as high in the Stockholm region (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.7-3.4) and three times higher in middle-north Sweden (OR 3.0; 95% CI 1.7-5.3) compared with the south of Sweden. Of the maternal factors, nulliparity was the strongest predictor (OR 6.3; 95% CI 5.1-7.9), followed by a prenatal belief that epidural analgesia would be needed (OR 3.5; 95% CI 2.8-4.4).
  
  
  CONCLUSIONS
  The hypothesis of the study was confirmed. The woman and her background as well as the local cultural practice in the delivery unit matter with regard to the use of epidural analgesia.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. erica.schytt@ltdalarna.se
authors.forename: Erica
authors.initials: E
authors.lastname: Schytt
authors.forename: Ulla
authors.initials: U
authors.lastname: Waldenström
mesh_terms: D000328:Adult; D000367:Age Factors; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003469:Culture; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006757:Hospital Units; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D016015:Logistic Models; D017533:Marital Status; D010298:Parity; D010353:Patient Education as Topic; D011247:Pregnancy; D012042:Registries; D012907:Smoking / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology