A new study published in Obstetrics & Gynecology looked at the link between structural racism and a lower use of pain-relieving epidurals in childbirth. While the research revealed that both Black and white women facing social inequities experience poorer obstetric pain management, Black women in general are about 10% less likely to receive neuraxial analgesia — a common and effective pain reliever that includes epidurals — during labor compared with white women.
Researchers used data provided by the Centers for Disease Control and Prevention on 1.7 million Black and white women in labor in 45 U.S. states and the District of Columbia. The average age of the women was 29 years old and nearly 23% of them were Black. The researchers looked at different Black and white inequity ratios — namely, low education rates, unemployment rates and incarceration rates. When compared to counties with low ratios of social inequity, the researchers found that giving birth at hospitals in counties with high social inequity was associated with a 16% reduced use of epidural for white women and a 28% drop in use for Black women.
Even though Black women are impacted more, Dr. Jean Guglielminotti, lead author of the study and assistant professor of anesthesiology at Columbia University Vagelos College of Physicians and Surgeons, said in a statement that a notable finding of the research is that both Black and white women are affected by poor pain management in childbirth, suggesting that inequities negatively impact everyone in the health care system “because the system is not operating at an optimal level when racism undermines policies, practices and procedures.”
What’s behind the drop in epidural use?
Access may play a role in substandard pain management during labor and childbirth. “There are many health care facilities across the country which have a paucity of trained anesthesia providers,” Dr. Kecia Gaither, director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, tells Yahoo Life.
Dr. Stephanie Hack, ob-gyn and founder of Lady Parts Doctor, tells Yahoo Life that “while access is part of the problem since the number of maternity care deserts is steadily growing, especially post Roe v. Wade, there are racial dynamics at play as well.” For example, research shows that Black Americans are frequently undertreated for pain compared to white patients. Maternal death rates also continue to spike in the U.S., with Black women in particular being nearly three times more likely to die from pregnancy-related causes than white women.
The preference for labor pain management is also influenced by cultural and religious beliefs, a lack of prenatal patient education, language barriers, fears and for some Black Americans, historical distrust in the field of medicine stemming from years of mistreatment. “Anecdotally, many of my Black patients are hesitant to have ‘that needle in my back,’” says Gaither.
Hack says that a lack of information and misinformation contribute to misunderstandings about epidurals. “For someone who is unsure or unable to sort through the evidence, it's considered easier and safer not to take the risk,” she says. Hack points out several myths about epidural during labor and delivery, including that it can cause paralysis. However, these fears aren't supported by evidence, she says. While some may experience temporary discomfort at the injection site, serious complications like paralysis are extremely rare. Another myth is that epidurals impact the baby, but the amount is minimal and does not negatively affect newborn health outcomes such as Apgar scores.
There's a common myth that having an epidural raises the likelihood of needing a cesarean section. While epidurals have been shown to prolong the second stage of labor — namely, pushing — by about 20 minutes, research shows that epidurals do not increase the chance of requiring a C-section. Another prevalent misunderstanding is that there's only a narrow window during labor when an epidural can be administered. But epidurals can be given at various stages of labor, as long as the patient can sit still for the procedure.
It’s worth noting that some people may not be candidates for epidural, such as those with bleeding or clotting disorders, certain types of brain or spine disorders or very low blood pressure.
How to advocate for better labor pain management
Experts say that patients need to be informed. That includes understanding the benefits and any risks of having an epidural and discussing them with a health care provider. It’s also important to make any pain management preferences known during prenatal visits, sharing them with the doctor and nurse.
Having support in the form of a family member or doula who accompanies the patient whenever possible can make a difference in terms of advocacy. Experts recommended that patients also know their rights, and understand that they have the right to informed consent and to make decisions about pain management during labor.