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.