• Cecilia Ekéus, Sven Cnattingius, and Anders Hjern.
• Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden. cecilia.ekeus@ki.se
• Acta Obstet Gynecol Scand. 2010 Jan 1;89(2):243-9.

ObjectiveTo investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight.DesignPopulation-based register study.SettingNationwide study in Sweden.PopulationA total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses.MethodsRegister study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers.Main Outcome MeasureUse of EDA during vaginal delivery.ResultsCompared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women.ConclusionEDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.

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