Patient Satisfaction and Preference Valuation in Neuraxial Labor Analgesia Across a Diverse Population

Diana M. Ruiz, BS; Lucy Shang, BA; Beilin Yaakov, MD; Daniel Katz, MD

April 30, 2026

Background and Hypothesis

Neuraxial Labor Analgesia (NLA) is the most effective method for labor pain relief.

Compared to non-neuraxial methods, NLA:

- Provides superior analgesia

- Reduces the need for additional pain control

- Improves maternal satisfaction

Disparities persist in LEA utilization:

- Lower use among Black, Hispanic, and Asian women compared to non-Hispanic White women

While utilization disparities are well documented, less is known about:

- Differences in patient satisfaction

- Variations in anesthesia-related preferences

Study Objectives:

- Assess differences in patient satisfaction with LEA

- Evaluate differences in patient preferences

Hypothesis:

- Satisfaction and preferences are similar across demographic and socioeconomic groups

Study Design and Methods

Design: Cross-sectional, single-site survey

Population: Postpartum patients after vaginal delivery

Outcomes:

- Satisfaction with LEA (0–100 scale)

- Preference valuation: Allocation of hypothetical $100 across 10 anesthesia-related outcomes

  - Higher dollar amount = greater perceived importance

Variables (dichotomized):

- Race/Ethnicity

- Income (> vs. ≤ $52,000)

- Education (< Bachelor’s vs. ≥ Bachelor’s)

- Insurance (Medicaid vs. Commercial)

- Marital Status

- Nationality (US-born vs. foreign-born)

Analysis:

- Descriptive statistics

- Independent Welch’s t-tests

- Significance threshold: p < 0.05

Results

The cohort was socioeconomically diverse.

Satisfaction:

- High overall: 92.8 ± 12.9

- No significant differences across demographic groups

Patient Preferences:

- Avoidance of labor pain = highest valued outcome

- Mean: $39.8 ± 25.9

- Consistent across subgroups

Key Differences in Pain Valuation:

- Higher among:

  - White non-Hispanic vs. non-White/Hispanic

  - Married vs. unmarried

Conclusion / Key Findings & Implications

High overall satisfaction:

- Neuraxial labor analgesia satisfaction was consistently high

- No significant differences across demographic or socioeconomic groups

Differences in patient priorities:

- White, non-Hispanic and married patients placed greater value on labor pain control compared to non-White/Hispanic and unmarried patients

Clinical Implication:

- Similar satisfaction scores may mask meaningful differences in patient priorities

- Highlights the need for patient-centered counseling in NLA

References

1. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5(5):CD000331.

2. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstetrics & Gynecology. 2019;133(3):e208–e225.

3. Glance LG, Wissler R, Glantz C, et al. Racial differences in the use of epidural analgesia for labor. Anesthesiology. 2007;106(1):19–28.

4. Craig R, El Nour S, Xuereb LB, et al. Racial and ethnic disparity in obstetric anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2025;80(7):757–770.