Factors affecting womens' attitude towards labor epidural analgesia in a culturally diverse population: a prospective patient-reported outcome study

Background: To evaluate pregnant women's intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel. Methods: A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression. Results: The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (P =0.024), childbirth preparation course (P =0.002), internet as source of information (P =0.016), and previous delivery with LEA (P <0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (P =0.033), partner presence (P <0.001), labor induction (P =0.044), and previous delivery with LEA (P <0.001). Conclusion: Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.