• Erica Schytt and Ulla Waldenström.
• Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. erica.schytt@ltdalarna.se
• Acta Obstet Gynecol Scand. 2010 Jan 1;89(2):238-42.

ObjectiveTo test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit.DesignPopulation-based cohort study.SettingAll delivery units in Sweden.PopulationA nationwide sample of 2,529 women.MethodsData were collected by questionnaires in early pregnancy and two months after birth, and from the Swedish Medical Birth Register. Logistic regression analysis was conducted, adjusted for gestational age, induction of labor and infant birthweight.Main Outcome MeasuresEpidural analgesia during labor.ResultsThe odds of having an epidural analgesia were more than twice as high in the Stockholm region (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.7-3.4) and three times higher in middle-north Sweden (OR 3.0; 95% CI 1.7-5.3) compared with the south of Sweden. Of the maternal factors, nulliparity was the strongest predictor (OR 6.3; 95% CI 5.1-7.9), followed by a prenatal belief that epidural analgesia would be needed (OR 3.5; 95% CI 2.8-4.4).ConclusionThe hypothesis of the study was confirmed. The woman and her background as well as the local cultural practice in the delivery unit matter with regard to the use of epidural analgesia.

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