- Non-native-English-speaking, Black, and Hispanic moms receive poor pain management post-C-section.
- The study follows other research showing racial disparities in pain assessment and treatment.
- Systemic racism and physician bias play a role.
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A woman's race and native language may influence how much and which type of pain medication she gets after a C-section, no matter how much pain she's actually experiencing, research presented in April shows.
Non-native English speakers receive fewer pain assessments and fewer medications than English speakers, the research showed. Black and Hispanic patients were negatively affected by the disparities too.
The report adds to a body of research demonstrating how systemic racism can play out in maternal and child healthcare.
Women reported similar levels of pain but received different doses
The research, presented at the American College of Obstetricians and Gynecologists' annual conference, looked at data on 327 women who underwent cesarean deliveries at a New York hospital between January 2018 and June 2018.
Lead study author Dr. Alison Wiles and colleagues reviewed how often clinicians assessed patients' pain, how often their pain was rated severe, and how much pain medication – both non-steroidal anti-inflammatory medications (NSAIDs) and opioids (OTE) – they were given.
They excluded patients who'd had C-section hysterectomies, received general anesthesia or pain meds through a self-controlled pump, had opiate allergies, or had a history of drug use.
The researchers found that Hispanic and non-native English speaking patients received the fewest pain assessments when compared to native English speakers, Black, white, and Asian patients.
The also found that NSAID doses were lowest in non-native English speakers within the first 24 hours of birth and among non-Hispanic Black patients 24 to 48 hours postpartum, despite all groups reporting similar levels of pain.
OTE doses, meanwhile, were lowest in Hispanic and non-English speaking patients and highest in Black patients 24 to 48 hours after birth. Since using NSAIDs soon after birth can reduce the need for opiates later, "there is an aspect of 'getting behind' on pain medication which can require stronger medications to control," Wiles told Insider.
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While there were limitations, like not differentiating between patients with some conditions like endometriosis that could have affected their dosages, the results demonstrate how language barriers can negatively affect care, the study authors wrote. They suggested scheduled around-the-clock pain assessments and delivery of non-opioid medications after birth.
"The study was not designed to identify why the disparities exist ... but other research in this area does show that physicians, nurses, and every realm of healthcare have biases about pain tolerance and race that potentially contribute to these disparities," Wiles said.
Other research and anecdotes demonstrate how race and language can affect postpartum care
Past research has also found racial disparities in women's care after cesarean deliveries.
One 2019 analysis including women who underwent C-sections at a North Carolina hospital between 2014 and 2016 found that Black and Hispanic women received fewer pain assessments and lower doses of both NSAIDs and opiates than white and Asian women - even though they said they were in more pain.
Anecdotal evidence also sheds light on how language barriers can affect how patients are treated. Dr. Jess Robinson, a Black OB-GYN, previously told Insider. Creole-speaking Haitian patients were uniquely discriminated against at the Florida hospital where she was a resident.
When Haitian pregnant patients developed pre-eclampsia, a potentially life-threatening blood pressure condition, clinicians frequently seemed to tend to them with less urgency than their white patients with the same condition, Robinson, whose real name is withheld to protect her from workplace retaliation, said.
"I would hear comments such as, 'She's Creole, they do this all the time' or, 'She's Haitian, she'll be fine' or, 'this is what their babies do,' without any further cause for concern."
Systemic racism and physician bias hurts Black patients, pregnant or not
The root causes of racial disparities in pain management are complicated, but one factor seems to be physician bias.
One 2016 study found that about half of white medical students and residents endorsed false beliefs about biological differences between Black and white people, like that Black people's nerve endings are less sensitive and their skin is thicker. In turn, they rated Black patients' pain as lower and made less accurate treatment recommendations.
Ashanti Coleman, a Black nurse in Memphis, previously told Insider she suffered the consequences. A doctor dismissed her second stroke as a migraine and discharged her without assessing her pain or conducting a neurological exam, she said. She could have died had she not gone to a different hospital the next day, when her pain was even worse.
Coleman said her pain wasn't treated at first because, as the neurologist told Coleman's primary care physician, "she doesn't look like she's in pain."
"They presume that individuals are not in pain because we're not presenting the way they think we should," Coleman said. "I wasn't writhing on the ground. I wasn't using profanity. But everyone's pain is different."