Does Speaking the Same Language With the Caretakers Associate With a Higher Neuraxial Labor Analgesia Use Rate?

Use of neuraxial analgesia requires communication between the parturient and her caretakers. In this retrospective study, the use of labor analgesia is compared between parturients whose primary language is other than Finnish or Swedish and who don't communicate in these languages or English without an interpreter (Category I), who communicate in Finnish, Swedish, or English (Category II), and primary Finnish or Swedish speakers (Category III). The primary outcome of this study is the association of communication language categories with neuraxial analgesia use. The secondary outcome is the incidence of vaginal delivery without pharmacological pain relief. The parturient and labor parameters (age, body mass index (BMI), primiparity, gestational age, prior consultations for fear-of-childbirth (FOC), induction of labor, use of oxytocin, labor analgesia interventions, outcome of the attempted labor) were recorded from the electronic patient database for all 13,707 parturients that attempted vaginal delivery in the Helsinki region delivery hospitals during 2022. The distribution of parturients was 15.3%, 10.3%, and 74.4% in the language categories I, II, and III, respectively. The use rate of neuraxial analgesia was 60.8%, 65.8%, and 75.3% in the categories I, II, and III respectively. After adjustment for primiparity, maternal BMI, gestational age, FOC diagnosis, induction of labor, oxytocin use, episiotomy, and outcome of labor, the adjusted OR (aOR) for neuraxial analgesia use was (1.283 [1.093-1.506]) among parturients in Cat II compared to Cat I. Correspondingly, the ability to communicate directly (Cat II) was associated with lower use of only non-neuraxial pharmacological analgesia (aOR 0.789 [0.654-0.951]) compared to those incapable of direct communication (Cat I). No association was seen with language capability (Cat II vs. Cat I) and delivery without pharmacological pain relief (any delivery type: aOR 0.815 [0.652-1.019]; vaginal delivery: aOR 0.825 [0.645-1.055]). Ability to communicate directly with the staff is associated with shifting from non-neuraxial techniques to neuraxial analgesia but not an increase in general labor analgesia use. Cultural trends may be associated with labor analgesia choices more than language capabilities. Promotion of labor analgesia use should go beyond translation services and requires antenatal education of the available options. EDITORIAL COMMENT: This study demonstrates that language ability alone does not determine labor analgesia use but instead shapes the selection of analgesia methods. Cultural context and antenatal knowledge appear to play a central role in analgesia decision-making. Efforts to promote equitable maternity care should therefore extend beyond translation services to include culturally responsive education and communication strategies that support informed maternal choice.