Women from minority backgrounds in the UK less likely to receive epidurals, research finds

New research has shown that women from black and Asian backgrounds are less likely to receive an epidural when giving birth compared to white women.

This study looked at data from over 2.7 million births in the UK. Experts are concerned about an 'ethnicity pain gap', meaning that people from ethnic minorities may not get enough pain relief in medical settings. This research highlights racial differences in pain relief across all areas of healthcare, from emergency rooms to care for cancer patients.

Four important medical organisations in the UK have asked for better ways to collect information about how patients from minority ethnic groups might experience their pain being ignored by healthcare providers. The study on pain relief for women giving birth was published in the journal Anaesthesia. It analysed data from a 10-year period up to 2021.

The findings indicated that women of Bangladeshi, Pakistani, and black Caribbean heritage were less likely than white women to get an epidural during a vaginal birth. Specifically, they were 24%, 15%, and 8% less likely, respectively. This follows a recent report by Valerie Amos, a member of the House of Lords, which detailed serious problems in UK maternity care, including women not being heard and poor initial assessments of pregnant women.

The research is similar to other reports from countries like the US and Australia, which have also shown instances of racism in how patients are treated. Bell Ribeiro-Addy, a Member of Parliament and chair of a group focusing on black maternal health, stated that the findings clearly show that biased ideas based on race are a major reason for these unequal results. She added that these differences in pain relief are shocking but not surprising, given the historical tendency to doubt or downplay the pain experienced by black people.

Dr Nuala Lucas, president of the Obstetric Anaesthetists’ Association and a co-author of the study, mentioned that women with health issues during pregnancy or those giving birth early often benefit greatly from effective epidural pain relief. She found it particularly worrying if these women are the least likely to receive it. The analysis also showed that black Caribbean-British women were 58% more likely than white women to be given general anaesthesia for planned caesarean births. Black African-British women were 35% more likely to receive general anaesthesia compared to white women.

Most caesarean sections are performed while the mother is awake using regional anaesthesia, like an epidural, because it is considered safer and allows for a faster recovery. General anaesthesia is usually reserved for emergencies when there isn't enough time for regional anaesthesia. The study adds to growing evidence of inequalities in maternity care, with past reports suggesting that black women are sometimes perceived by maternity staff as being able to tolerate more pain, while Asian mothers might be seen as overly demanding.

Research from the University of Oxford also revealed significant differences in how black and Asian women receive help for pain during labour. Many women from these backgrounds felt their concerns about pain relief options were dismissed or ignored by healthcare professionals. They also expressed fear about speaking up and felt excluded from decisions regarding their pain management.

The study concluded that various factors affect the experiences of women from ethnic minority backgrounds during childbirth. This includes a general feeling of distrust between these women and their healthcare providers. Dr Lisa Hinton, the lead author, emphasized that understanding the reasons behind these figures is crucial. She believes that communication and trust play a significant role, alongside access to treatment, and that women need open discussions about their pain relief options.

Fiona Gibb, director of midwifery at the Royal College of Midwives, stated that any suggestion that women's pain is not taken seriously or that access to pain relief differs by ethnicity is unacceptable. She stressed the need for more consistent data collection to identify and address inequalities. Dr Christine Ekechi from the Royal College of Obstetricians and Gynaecologists noted that data shows black and brown women are less likely to receive an epidural when requested. She stressed the importance of understanding why this happens and closing the gap.

Ribeiro-Addy suggested that ending inequalities in maternal care requires looking at everything from cultural factors to resources and staffing. She highlighted that reports consistently show black women facing discrimination and unequal care in maternity settings. She called for a stronger anti-racist culture in healthcare institutions and sufficient staffing and funding to ensure all women receive high-quality care.

Kate Brintworth, chief midwifery officer for NHS England, affirmed that racism and discrimination have no place in the NHS. She stated that every pregnant woman should be listened to and involved in decisions about her pain relief. She acknowledged that such issues negatively impact mothers and babies from ethnic minorities and deprived communities, leading to poorer outcomes. The NHS is introducing mandatory equality and anti-discrimination training for all staff by the end of the year.