As the fight to lower the black maternal mortality rate continues, two new studies provide new evidence of stark contrasts in the way black and brown new mothers are treated postpartum, versus their white counterparts. Specifically, “Racial Disparities in Postpartum Pain Management” and “Racial and Ethnic Inequities in Postpartum Pain Evaluation and Management,” both published in the journal Obstetrics & Gynecology on Nov. 4 (h/t Reuters Health), found that post-delivery, white mothers are more likely to receive increased attention to, and assessments of, their pain and more access to pain medication than women of other races or ethnicities.
The former of the two studies surveyed 9,900 postpartum women, asking them to rate their pain on a scale of 1 to 10, with 10 being the worst. Data collected found that Hispanic women were 61 percent more likely to report scores of 5 or higher, while black women were more than twice as likely to report pain on the higher end of the scale. And yet, these same women were given fewer milligrams of morphine than the white mothers surveyed—and were less likely to be prescribed opioids to help manage their pain after being discharged.
“Our study shows black and Hispanic women experience disparities in pain management in the postpartum setting,” study leader Dr. Nevert Badreldin of Chicago’s Northwestern University Feinberg School of Medicine said in a statement to Obstetrics & Gynecology. “These disparities cannot be explained by less perceived pain.”
Some may argue that less opioid prescriptions are a good thing, given the country’s current opioid epidemic. This concern is echoed by Dr. Brian Bateman of Brigham and Women’s Hospital and Harvard Medical School in Boston and Dr. Brendan Carvalho of Stanford University School of Medicine in California, the authors of an editorial accompanying the studies, “Addressing Racial and Ethnic Disparities in Pain Management in the Midst of the Opioid Crisis.” In it, the two express “caution against responding to these differences by increasing opioid prescribing.”
However, it’s also worth taking into account the myriad pain issues women experience after giving birth, including uterine cramps, vaginal lacerations, musculoskeletal pain and pain from surgical incisions during delivery. How those injuries were assessed and treated by medical personnel was the focus of the second study, which again asked women to report their pain, with 10 as the highest metric.
Of 1,701 women surveyed, 28 percent of black mothers reported postpartum pain scores of at least 7 out of 10, compared to 22 percent of Hispanic women, 20 percent of white women, and 15 percent of Asian women. But once again, disparities were found: within the first 24 hours after delivery, white mothers were asked about their pain levels an average of 10.2 times, compared with 8.4 to 9.5 times for mothers of other races and ethnicities.
“Any disparities in the care that women receive require urgent attention,” Drs. Bateman and Carvalho concede, noting that the mortality rate for black and Native American mothers over 30 is four to five times higher than for white mothers. They also note that “there are study limitations that require further consideration” when considering what the disparities revealed and how to remedy them.
However, what is not debatable is that the disparities exist, and may well be contributing to the morbidity of black mothers and children. The findings also dovetail with previous studies that have found racial bias in how black patients’ pain was evaluated and treated in contrast to their white counterparts, as well as testimonials from black mothers—including Serena Williams—who recall their reports of pain or concerns being dismissed or downplayed.
Further research isn’t required to recognize a dangerous trend that requires immediate action by the clinicians tasked with caring for and delivering both babies and mothers into the postpartum experience safely.