Analysis of rejection of epidural analgesia during labor in Andalusian women: >the silent sufferer> | Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: >la buena sufridora>

Abstract

Introduction: Knowledge and use of epidural analgesia has become increasingly widespread in Spain over the last 20 years. In Andalusia (southern Spain), expectant mothers have the right to choose this analgesic technique during labor and delivery, an option that depends solely on the physical or health status of the mother or the availability of the resources at the hospital at the time of childbirth. Preference is determined by two interrelated factors. Firstly, a cognitive component, which is influenced by the values, perceptions and culture of the mother and, secondly, a behavioral component, i.e., the acceptance or rejection of the technique, which will depend not only on the motives determining the choice, but on the possibility of choosing epidural analgesia as well as the above-mentioned conditioning factors. Objective: To determine the characteristics of women in Andalusia who refuse epidural anaesthesia during labor, even when this analgesic technique is readily available to them. Material and methods: Annual surveys on user satisfaction with hospital care in Andalusia conducted from 2000-2007 were used, specifically data provided by women who gave birth in public hospitals in Andalusia. Based on these data, a hierarchical segmentation analysis was conducted to determine the profile of women who refused this analgesic technique. Results: Educational level, income and employment status played a significant role in rejection of epidural anaesthesia during labor. Conclusions: The social, economic and cultural factors underlying rejection, that is, the profile of women who reject epidural analgesia, is consistent with the paradigm of the >traditional woman> (characterized by limited income, low educational level and mainly occupied by housework) studied by other authors. Given the universal use of this procedure in Andalusia, rejection of epidural analgesia can be interpreted as yet another indicator of inequality in healthcare due, in this case, to gender-related attitudes and values characteristic of patriarchal societies. © 2010 Sociedad Española del Dolor.