Major regional differences in the use of labor analgesia in Finland – A national register study

•Past studies on labor analgesia mainly focused on neuraxial techniques.•Major regional differences in labor analgesia were seen in Finnish hospitals.•Nitrous oxide, epidural and non-pharmacologic methods were the top three used.•Pudendal analgesia rouse nearly to paracervical levels in 2019. Labor analgesia should be equally available to every woman giving birth. However, previous studies have found notable regional differences between countries and regions in the use of epidural analgesia. We aim to evaluate the trends in the use of different labor analgesia methods in Finnish hospital districts. We performed a nationwide retrospective register-based cohort study. From January 1, 2007 to December 31, 2019, we collected vaginal birth data concerning used labor analgesia from the national Finnish Medical Birth Register. Cesarean sections were excluded because of the missing labor analgesia data from the elective operations. Data were grouped and interpreted based on 19 hospital districts in Finland. There were 567 593 vaginal births during the years 2007–2019. Major differences were observed in the use of labor analgesia between hospital districts. The trends also varied during the study period within the same hospital district. Neuraxial analgesia was the most used during the study period – on average 63.6 % of the deliveries had neuraxial analgesia. It was followed by nitrous oxide by 58.0 %. Interestingly, the rates of non-pharmaceutical analgesia increased the most during the study period. The results showed major differences in the use of different labor analgesia methods between Finnish hospital districts, and the analgesia policies do not seem to be nationwide.