title: The use of epidural analgesia for intrapartum pain relief in publicly funded healthcare.
abstract: BACKGROUND
  Epidural analgesia is the most effective way to relieve pain during birth. In a population-based case-control study, we evaluated whether socioeconomic status (SES) affects the use of epidural analgesia for intrapartum pain relief in publicly funded health care.
  
  
  METHODS
  Data gathered from the Finnish Medical Birth Register included all singleton births (n = 521,179) in 2000-2010. The likelihood of receiving epidural analgesia according to vaginal birth order, socio-demographic factors and delivery characteristics was determined by using logistic regression analysis.
  
  
  RESULTS
  Overall, 66.6% of women with first vaginal births and 22.4% of women with second or subsequent vaginal births had epidural analgesia. The use of epidural analgesia was associated with several factors, such as post-term pregnancy, gestational diabetes, maternal diabetes mellitus, single marital status, smoking, depression and fear of childbirth, induction, high birth weight and giving birth by vacuum extraction regardless of vaginal birth order. Epidural use did not vary substantially by SES in first vaginal births, but a minor difference was found in second or subsequent vaginal births. The prevalence of epidural analgesia was 3% [adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.93-1.00] and 13% (aOR 0.87, 95% CI 0.83-0.90) lower among lower white-collar workers and blue-collar workers, respectively, compared with upper white-collar workers.
  
  
  CONCLUSIONS
  In Finland, the use of epidural analgesia for intrapartum pain relief reflected clinical indications and did not substantially vary by SES regardless of vaginal birth order. This could be considered as an important indicator measuring health equality.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Räisänen
authors.forename: Merja
authors.initials: M
authors.lastname: Kokki
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D001722:Birth Order; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D011247:Pregnancy; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult