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Poster Session 1

Category: Health Equity/Community Health

Poster Session 1

(279) Nativity and Regional Anesthesia Use in Vaginal Deliveries: Comparing United States and Foreign-Born Individuals

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Presenting Author(s)

Lucy Qi, BS (she/her/hers)

Student
Thomas Jefferson University College of Population Health, Philadelphia, PA, USA
Hockessin , Delaware, United States

Submitting Author(s)

Leshae A. Cenac, MD (she/her/hers)

Fellow Physician
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
Philadephia, Pennsylvania, United States

Coauthor(s)

Rodney A. McLaren, Jr, MD

Maternal Fetal Medicine Attending
Maimonides Medical Center
Brooklyn, New York, United States
Huda B. Al-Kouatly, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
Philadelphia, Pennsylvania, United States

Objective:
Epidural anesthesia is widely used for labor pain management in the United States. While prior research shows disparities by race and socioeconomic status, there is still a significant gap in knowledge of nativity and epidural use in the United States. Thus, the objective of this study was to evaluate differences in regional anesthesia use during vaginal deliveries between United States-born and foreign-born individuals.

Study Design:
A population-based retrospective analysis was conducted on births with singleton vaginal deliveries using data from the National Vital Statistics from 2016 to 2023. Births by cesarean delivery, multifetal gestations, < 23 or >42 weeks, congenital anomalies, or missing variables were excluded. The primary outcome was regional anesthesia use. Multivariable logistic regression assessed the association between nativity status and regional anesthesia use, adjusting for demographic and clinical factors.

Results:
Of the 17,653,560 included births, 3,878,084 (22.0%) were from foreign-born individuals and 13,775,476 (78.0%) were from United States-born individuals. Births from foreign-born individuals had significant differences in age, insurance, and education compared to United States-born individuals, Table 1. After adjusting for differences in multiple sociodemographic and clinical factors, regional anesthesia use was more prevalent among United States-born compared to foreign-born individuals (75.0% vs. 68.1%; aOR: 0.86, 95% CI 0.86-0.87), Table 2.

Conclusion:
Foreign-born individuals were significantly less likely to receive regional anesthesia during vaginal delivery in the United States, even after adjusting for multiple sociodemographic and clinical factors. These findings highlight the importance of addressing nativity status as a distinct and under-recognized factor in maternal pain management disparities. Future research is needed on interventions addressing communication barriers, cultural beliefs, and informed decision-making on regional anesthesia use.