Inbox — June 2017
Tex Med. 2017;113(6):6.
I read with great interest the commentary, "Epidural Use Disparities by Spanish-Speaking People in Labor," by Estevan A. Apodaca, MD, a family medicine resident, and Swati B. Avashia, MD, a family medicine attending, in the November 2016 issue of Texas Medicine.
I am a practicing OB-Gyn in Dallas, having completed medical school in San Antonio and training at Parkland/UT-Southwestern. I am fluent in Spanish and a strong advocate of epidural use during labor. I encourage the use of epidurals in my patients, including those who speak only or mostly Spanish. I commonly encounter deep resistance to epidural use in this population. Sometimes, they are afraid it will hurt, or they have a "friend" who had serious complications from an epidural. Many times, when I offer an epidural to a patient who only speaks Spanish, she turns to her husband for approval. I routinely attempt to educate and involve my patients in the epidural discussion, and usually they feel comfortable and proceed. What remains clear is that a cultural bias or fear leads to hesitancy to ask for or agree to epidural use.
The original commentary was based on Dr. Apodaca's observations during his time on labor and delivery, which could represent isolated incidences over a short time span or even just phenomena seen more commonly at his institution. Other than a single anecdote, I didn't find anything in the commentary to suggest that the well-established racial disparity of epidural use was attributable to mistreatment by a health care team, rather than a cultural bias against use.
I suggest education beginning in mid-pregnancy. I have found that having two discussions preceding labor usually helps the patient make a better-informed decision. This will be a challenge in academic institutions, where the patient rarely sees the same doctor twice during prenatal care; however, educating to eliminate the misinformation should be the goal.
Blake Frieden, MD
Dallas
June 2017 Texas Medicine Contents
Texas Medicine Main Page
Last Updated On
July 17, 2023
Originally Published On
May 25, 2017