• Sari Räisänen, Merja Kokki, Hannu Kokki, Mika Gissler, Michael R Kramer, and Seppo Heinonen.
• Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.
• Acta Anaesthesiol Scand. 2014 Mar 1; 58 (3): 291-7.

BackgroundEpidural analgesia is the most effective way to relieve pain during birth. In a population-based case-control study, we evaluated whether socioeconomic status (SES) affects the use of epidural analgesia for intrapartum pain relief in publicly funded health care.MethodsData gathered from the Finnish Medical Birth Register included all singleton births (n = 521,179) in 2000-2010. The likelihood of receiving epidural analgesia according to vaginal birth order, socio-demographic factors and delivery characteristics was determined by using logistic regression analysis.ResultsOverall, 66.6% of women with first vaginal births and 22.4% of women with second or subsequent vaginal births had epidural analgesia. The use of epidural analgesia was associated with several factors, such as post-term pregnancy, gestational diabetes, maternal diabetes mellitus, single marital status, smoking, depression and fear of childbirth, induction, high birth weight and giving birth by vacuum extraction regardless of vaginal birth order. Epidural use did not vary substantially by SES in first vaginal births, but a minor difference was found in second or subsequent vaginal births. The prevalence of epidural analgesia was 3% [adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.93-1.00] and 13% (aOR 0.87, 95% CI 0.83-0.90) lower among lower white-collar workers and blue-collar workers, respectively, compared with upper white-collar workers.ConclusionsIn Finland, the use of epidural analgesia for intrapartum pain relief reflected clinical indications and did not substantially vary by SES regardless of vaginal birth order. This could be considered as an important indicator measuring health equality.© 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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