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Childbirth pain relief study reveals inequalities for BAME mothers

Addenbrooke’s Hospital is helping with research that highlights inequalities in pain relief and anaesthesia for women of black, Asian, and minority ethnic backgrounds.

Dr Jim Bamber
Dr James Bamber

The findings have just been published in Anaesthesia - a journal of the Association of Anaesthetists – authored by experts including Dr James Bamber, an anaesthesia consultant with Cambridge University Hospitals NHS Foundation Trust (CUH).

The study examined data collected from more than 2.7m births in the UK between March 2011 and February 2021, with a particular focus on ethnicity and differences in obstetric anaesthetic care, adjusting for differences like health and age, location, and previous deliveries.

The study concluded:

  • For vaginal births, Bangladeshi-British (by 24%), Pakistani-British (by 15%) and black Caribbean-British (by 8%) women are less likely than white women to receive an epidural.
  • Black women are approximately 40% less likely to have an assisted vaginal birth (forceps/ventouse [suction] delivery) compared to white women but instead are more likely to have an emergency caesarean birth.
  • Black Caribbean-British women in the UK are 58% more likely than white women to be given general anaesthesia for elective caesarean births; for Black African-British women, they are 35% more likely to have general anaesthesia.
  • For emergency Caesarean births, black Caribbean-British women are 10% more likely than white women to be given general anaesthesia.

Dr Bamber and his colleagues say reasons for the differences are unknown, but further research is needed to see if improvements can made to reduce any inequalities in the different types of pain relief and anaesthesia received.

Other studies that have found differences in obstetric anaesthesia care between ethnic or racial groups have mostly come from the USA, where access to healthcare maybe determined by insurance or economic status.

But the new study examined the NHS, where care is provided free and access to obstetric care and anaesthesia choices should not be limited by financial circumstances.

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, such as the interpretation of the labour pain from different ethnic groups.

The authors conclude:

It behoves health professionals and providers to ensure any differences in anaesthesia 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 anaesthetic care is equitable, the information provided in maternity care on the choices for anaesthesia and analgesia must be easily accessible in terms of availability, language and readability, and should be culturally cognisant.

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.

Dr James Bamber

Other study authors included: Dr Nuala Lucas, consultant, Department of Anaesthesia, London North West University Healthcare NHS Trust, Harrow, and Marian Knight, professor of maternal and child population health at the National Perinatal Epidemiology Unit, University of Oxford.

The paper can be read at (opens in a new tab)