Women on Medicaid Less Likely to Receive Epidural During Delivery, Study Finds

Women covered under Medicaid are less likely to receive an epidural during labor than women with "traditional private insurance," according to a study published in the May issue of the Journal of Health Care for the Poor and Underserved. Reuters Health reports that Dr. Thomas Obst, director of the nurse anesthesia program at the State University of New York at Buffalo, followed more than 12,000 New York women who gave birth in 1992. Obst found that women on Medicaid were "less than half as likely" to receive an epidural during vaginal delivery than women with traditional private insurance. Women with HMO coverage, while more likely than those on Medicaid to receive an epidural, were less likely than women with traditional insurance coverage to receive the treatment. And women insured under Medicaid were "more likely to receive no anesthesia at all" during vaginal delivery: more than one-third received no anesthesia, while 18% of HMO patients and 22% of women with private insurance received no pain control. Obst said, "This study provides evidence of differences across New York State in the availability of obstetrical pain control which, until now, have not been well measured."

Race Also a Factor
Reuters reports that while insurance coverage was "the strongest factor" in determining whether women received epidurals, race was also a factor. The study found that white women were more likely than African-American women to receive an epidural during vaginal delivery. And Obst noted that his findings "suggest that other factors also influence the type of anesthesia care a women receives, such as patient and provider preferences." He called for a "broader national assessment of pain control options for obstetrical patients," noting that his study was limited to "one state and one year of data" (Pallarito, Reuters Health, 5/1).