Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France

Brebion, Myriam; Bonnet, Marie‐Pierre; Sauvegrain, Priscille; Saurel‐Cubizolles, Marie‐Josèphe; Blondel, Béatrice; Deneux‐Tharaux, Catherine; Azria, Élie; Anselem, O.; Cognet, Marguerite; Duquesnois, Sylvie; Guedj, Romain; Linard, Morgane; Ngô, Charlotte; Richetin, Juliette; Rousseau, Anne; Saurel, Marie-Josèphe

doi:10.1016/j.bja.2021.08.011

Cited by 6 publications

(10 citation statements)

References 21 publications

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“…In support of this theory, a French study among women who had initially expressed a preference for NA reported no differences in its use rates between natives and migrants. 15 Although we had no information on analgesia preferences, the fact that satisfaction with pain management did not differ by language proficiency could indicate that women’s preferences were met. Even so, the question as to whether these preferences are mirroring women’s cultural or spiritual appreciation of natural birth or reflecting a lack of analgesia-related knowledge and communication difficulties with their care providers, or a mixture of both, remains to be solved.…”

Section: Discussionmentioning

confidence: 95%

“…3,11,14,31 This is particularly relevant for women from countries with a limited provision or nonstandard use of pharmacological analgesia. In Portugal, all women have the right to free maternal care services—including obstetric analgesia—in the national health services 15 and analgesia-related information is typically provided during prenatal visits and/or prenatal classes. This means that all women should theoretically have similar access to analgesia-related knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, a recent study in France found that when solely including women who expressed a preference for NA before labor, NA utilization did not differ significantly between natives and migrants. 15 However, migrants from countries with very high Human Development Index (HDI) were more likely to receive NA. 15 Most literature exploring migrant-native disparities in anesthetic labor care focused on nonmigrantspecific factors like sociodemographic (eg, maternal age, income, insurance, education) and obstetric factors (eg, parity, induction of labor, fetal birth weight, and presentation).…”

mentioning

confidence: 99%

“…15 However, migrants from countries with very high Human Development Index (HDI) were more likely to receive NA. 15…”

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confidence: 99%

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Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency

Hamwi

Barros

Lorthe

2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives. METHODS: We conducted a secondary analysis of data collected from 1024 native and 1111 migrant women who had singleton vaginal deliveries between 2017 and 2019 and were enrolled in the nationwide Portuguese baMBINO prospective cohort study. Obstetric NA use, satisfaction with labor pain management, and migrants’ Portuguese language proficiency were self-reported. Data were analyzed using robust multilevel Poisson regression, adjusted for maternal region of birth (characterized by the Human Development Index), age, and education. RESULTS: Overall, 84.4% of native women gave birth with NA, compared to 81.6%, 71.3%, and 56.9% of migrant women with full, intermediate, and limited language proficiency, respectively. Compared to native women, migrants with intermediate (adjusted risk ratio [aRR] = 0.91 [95% confidence interval {CI}, 0.82–0.99]) and limited (aRR = 0.73 [95% CI, 0.56–0.94]) proficiency were less likely to receive NA. However, no significant differences were observed in pain management satisfaction by language proficiency level. CONCLUSIONS: Compared to native women, we observed a differential obstetric NA use across migrant women with different host-country language proficiency levels in Portugal, without affecting satisfaction with labor pain management. Although defining the mechanisms underlying NA use discrepancies requires further research, our findings support systematically evaluating pregnant migrant women’s linguistic skills and ensuring their access to adequate obstetric analgesia-related information and interpretation services.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…15 However, migrants from countries with very high Human Development Index (HDI) were more likely to receive NA. 15…”

mentioning

confidence: 99%

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Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency

Hamwi

Barros

Lorthe

2023

Anesthesia &Amp; Analgesia

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“…Neuraxial analgesia is considered the most effective method for reducing pain during labor and decreasing the risk of postpartum depression [ 19 , 20 ]. However, the historical estimated overall prevalence of neuraxial analgesia use in China was 10% [ 21 ], while this ratio in France and the United States was 88% and 73%, respectively [ 4 , 22 ]. Meanwhile, the rate of cesarean delivery in China was among the highest worldwide in 2007 (46%) and 2014 (35%) [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Wang

Xu²,

Zhao³

et al. 2022

BMC Anesthesiol

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Background Humane treatment requires the provision of appropriate sedation and analgesia during medical diagnosis and treatment. However, limited information is available about the status of procedural analgesic interventions in Chinese hospitals. Therefore, a nationwide survey was established to identify challenges and propose potential improvement strategies. Methods Forty-three members of the Pain Group of Chinese Society of Anesthesiology established and reviewed the questionnaire, which included (1) general information on the hospitals, (2) the sedation/analgesia rate in gastrointestinal endoscopy, labor, flexible bronchoscopy, hysteroscopy in China, (3) staff assignments, (4) drug use for procedural analgesic interventions, and (5) difficulties in procedural analgesic interventions. The data were obtained using an online questionnaire sent to the chief anesthesiologists of Chinese hospitals above Grade II or members of the Pain Group of Chinese Society of Anesthesiology. Results Valid and complete questionnaires were received from 2198 (44.0%) hospitals, of which 64.5% were Grade III. The overall sedation/analgesia rates were as follows: gastroscopy (50.6%), colonoscopy (53.7%), ERCP (65.9%), induced abortion (67.5%), labor (42.3%), hysteroscopy (67.0%) and fiber bronchoscopy (52.6%). Compared with Grade II hospitals, Grade III hospitals had a higher proportion of procedural analgesic interventions services except for induced abortion. On average (median [IQR]), each anesthesiologist performed 5.7 [2.3—11.4] cases per day, with 7.3 [3.2—13.6] performed in Grade III hospitals and 3.4 [1.8—6.8] performed in Grade II hospitals (z = -7.065, p < 0.001). Conclusions Chinese anesthesiologists have made great efforts to achieve procedural analgesic interventions, as evidenced by the increased rate. The uneven health care provided by hospitals at different levels and in different regions and the lack of anesthesiologists are the main barriers to optimal procedural analgesic interventions.

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Postpunktionskopfschmerz in der Geburtshilfe

et al. 2022

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Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France

Cited by 6 publications

References 21 publications

Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency

Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Postpunktionskopfschmerz in der Geburtshilfe

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