Disparities in Pain Evaluation and Treatment During Labor: A Racial and Ethnic Perspective

Background/Objectives: In the United States, maternal morbidity is 2-3 times higher than in other high-income nations and continues to rise among non-White women. One potential driving factor is whether labor and childbirth pain are assessed and addressed in a timely and effective manner. Pain during labor and childbirth can be symptomatic of maternal morbidity (e.g., pelvic pain, bleeding, high blood pressure, cardiovascular issues) and/or an independent predictor of adverse postpartum outcomes (e.g., chronic postpartum pain, postpartum depression). Methods: Since racial and ethnic disparities in pain reporting and treatment are well documented in other settings-such as chronic pain conditions, pregnancy-related pain, and postpartum care-we hypothesize that similar disparities persist during labor and delivery. In this manuscript, we evaluate differences in pain reporting and provider treatment response (or lack thereof) based on self-reported race and ethnicity during childbirth admission. Results: In a large, representative sample of women giving birth at a large hospital system (N = 46,671), we assessed race- and ethnicity-related disparities in pain reporting, evaluation, and treatment. There are racial disparities in the frequency of pain assessments, values of pain ratings, and delivery of pharmacological vs. non-pharmacological treatment. Conclusions: A large-scale investigation into racial and ethnic differences in pain assessment, reporting, and treatment during childbirth may help identify mechanisms that mitigate disparities in maternal morbidity and mortality.