Ethnic Differences in Obstetric Anesthesia Care Observed

An epidural is a relatively safe intervention that can provide excellent pain relief for labor that can improve the parental birthing experience. The World Health Organization (WHO) has recommended epidural analgesia for healthy pregnant women requesting pain relief during labor, depending on a woman’s preferences. Recent research has found that the use of epidural pain relief in labor has also been associated with less risk of severe complications for the mother during labor and delivery, and that babies born to women who had epidural pain relief may have better childhood developmental outcomes.

General Anesthesia During Delivery

It is known that there are differences in maternal and neonatal outcomes for women from different ethnic groups in the UK. The maternal death rate in black women is four times that of white women and there is a higher incidence of stillbirth, preterm labor and fetal growth restriction in South Asian and black women compared with white women. Minority ethnic women reported a poorer maternity care experience than white women. However, until now, there has been no published study of the relationship between ethnicity and obstetric anesthetic care in the UK.

In this new study, using routine national maternity data for England (hospital episode statistics admitted patient care) collected between March 2011 and February 2021, involving data for 2,732,609 births, the authors investigated ethnic differences in obstetric anesthetic care adjusting for any differences between ethnic groups for maternal age; geographical residence; deprivation; year of delivery; number of previous deliveries; and pre-existing health conditions including obesity.

This study found that Black Caribbean-British women in the UK were 58% more likely than white women to receive general anesthesia during elective cesarean births and Black African-British women were 35% more likely. For emergency cesarean births, Black Caribbean-British women are 10% more likely than white women to have general anesthesia.

Compared to white women who had vaginal births, Bangladeshi-British women were 24% less likely to have an epidural, whilst Pakistani-British women were 15% less likely and Black Caribbean women 8% less likely.

Other studies that have found differences in obstetric anesthesia care between ethnic or racial groups have mostly come from the USA, where access to healthcare maybe determined by insurance or economic status. The authors say, “In contrast to other published studies of obstetric anaesthetic care by ethnicity, the care of the women in our dataset was provided within an integrated national healthcare system, where care is provided free at the point of access and where a woman’s access to obstetric care and her anesthesia choices should not be limited by her personal financial circumstances.”

The authors note the limitations of their study, which include that it is observational and therefore cannot explain the reasons for the differences found. In addition, the study analysis depended on the accuracy of the data collected by hospitals. Furthermore, there may be other unknown factors, not collected in national statistics, about how a woman’s labor and delivery was managed, that were not accounted for in the analysis and may have contributed to the differences found in the study.

The authors discuss how differences in the maternity care given to women with different ethnicity may arise from barriers to information and knowledge, as well as barriers to choosing how and where care is provided. There can also be empathy biases from healthcare professionals, for example the interpretation of the labour pain experience of women from different ethnic groups.

The authors conclude: “Ethnic disparities may reflect different cultural attitudes in different ethnic communities and arise from positive maternal preferences and choices. However, it behaves health professionals and providers to ensure any differences in anesthesia rates are not due to inequities in the access, delivery or quality of care before they are attributed to personal or cultural preferences. To ensure that obstetric anesthetic care is equitable, the information provided in maternity care on the choices for anesthesia and analgesia must be easily accessible in terms of availability, language and readability, and should be culturally cognizant. There is a need to listen better to women from ethnic minorities so as to avoid health professional misconceptions and presumptions about women’s expectations and experiences of their perinatal care.”

Source: Eurekalert