A scoping review of barriers experienced by underserved and rural maternal populations in accessing epidural analgesia in the United States.

Access to epidural analgesia remains limited, particularly for high-risk underserved US women. Our scoping review aims to identify barriers experienced by US underserved and rural pregnant women in gaining access to epidurals and to review the scope of current interventions that exist to address these concerns. The Arksey and O'Malley York methodology was used as guidance for this review and consists of five steps: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. The Joanna Briggs Institute (JBI) recommendations were also used for the extraction, analysis, and presentation of results in this scoping review. 10 studies were retained for analysis. Of the various SDOH identified, those related to social and community context had the highest rates, and among the SDOH, race was the most prevalent. Barriers encountered by US underserved and rural maternal populations in accessing epidural analgesia fell at the individual level (n = 27), followed by organizational (n = 25), interpersonal (n = 18), social/political (n = 17), and community levels (n = 10). Major themes in future directions were identified through qualitative thematic analysis to address gaps in access and utilization of epidural analgesia in underserved US women. SDOH and systemic barriers play a role in hindering access to and utilization of epidural analgesia. Efforts to improve access to epidural analgesia through multifaceted, culturally responsive, and systemic interventions are required to address informational gaps and structural challenges.