• E R Weinstein, J Aaronson, S E Abramovitz, D McCullough, R Gotian, and R S White.
• Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Albert Einstein College of Medicine, The Bronx, NY, USA.
• Int J Obstet Anesth. 2024 Nov 14; 61: 104294104294.

BackgroundStudies have identified widespread variation in neuraxial labor analgesia use by race, ethnicity, and geographic location. However, limited research has investigated patient-level factors in the decision not to use neuraxial analgesia for labor.MethodsWe conducted semi-structured interviews at a New York City medical center from October 1, 2022, to May 30, 2023. Participants had delivered vaginally and selected not to receive neuraxial labor analgesia. Structured demographic questions were asked after interview completion. Interviews were recorded and transcribed verbatim. We analyzed data and grouped responses into themes according to grounded theory.ResultsWe identified five themes encompassing the main factors participants had considered when deciding not to receive neuraxial analgesia for birth: preferences for a natural birth experience, an empowering and supportive labor environment, preparation or preparedness for birth without medication, positive outlook on labor pain, and information, misinformation, knowledge gaps and fears about the epidural. All study participants mentioned these overarching themes in their interviews.ConclusionsParticipants described various factors important in their decision to give birth without an epidural, which we mapped onto five primary themes. Our results can be used to guide effective patient-provider interactions centered on mutual understanding, evidence-based medicine, and honoring patients' wishes. The information gathered may provide insight into how providers can incorporate shared decision-making into their practice.Copyright © 2024 Elsevier Ltd. All rights reserved.

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