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Ethnic differences influence care giver's estimates of pain during labour
Einat K Sheiner1, Eyal Sheiner, Ilana Shoham-Vardi
1Department of Obstetrics and Gynaecology, Ben Gurion University of the Negev, Beer-Sheva, Israel Faculty of Health Sciences, Soroka Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer-Sheva, Israel Epidemiology and Health Services Evaluation Department, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Abstract:
The present study compared the childbirth experience of two different ethnic groups living in the same area and sharing the same medical facilities. We investigated the influence of ethnic differences between patient and care provider on the interpretation of pain. The subjects were 225 Jewish and 192 Bedouin parturients, who were prospectively evaluated for their labour pain experience. The pain intensity level was assessed by the parturient ('self-reported pain') and by a Jewish doctor and midwife ('exhibited pain') in the initial active phase of labour, using the visual analog scale (VAS). On the day after delivery, the women were asked to evaluate the present pain intensity level. Although the means of the self-assessments of pain intensity levels at the initial active phase of Jewish and Bedouin parturients were similar (8.55 and 8.53 respectively, P = 0.25), the Jewish medical staff interpreted Bedouin women to experience less pain than Jewish women (6.89 vs. 8.52, P < 0.001). On the day after delivery, the Jewish women's evaluation of their pain intensity levels again resembled that of the Bedouin women (2.02 and 2.11 respectively, P = 0.52). The Pearson correlation coefficients between the measures of self-reported and exhibited pain, were higher for Jewish than for Bedouin women (0.74 and 0.63, respectively). In a multiple linear regression analysis, both self-reported and exhibited pain scores were associated significantly with ethnicity and parity. In the model predicting exhibited pain, the level of religious observance was negatively associated with pain intensity scores. We conclude that the ethnic background of the care provider is an important determinant in estimating the suffering of the patients. It is important for the clinician to be aware of the wide spectrum of factors that might influence pain expression and interpretation. The knowledge that there are inter-ethnic differences might prevent a stereotyped response to the patient in pain.