Discrimination, racism, and bias in childbirth pain management in the United States: a scoping review and directions for research and clinical care

Racial and ethnic disparities in obstetric analgesia care persist in the United States. There is a paucity of validated tools to measure how discrimination, racism, and bias affect obstetric anesthesia care. As a result, little is known about how racism and other forms of discrimination impact pain management during childbirth. In this scoping review, we evaluated 11 studies that quantitatively measured or qualitatively described experiences of discrimination, racism, or bias in childbirth pain management among birthing people in the United States. Studies focused on birthing people with marginalized identities due to race and ethnicity, disability status, history of opioid use disorder, and health insurance status. We provide nine recommendations for research and 14 recommendations for clinical practice to mitigate the impact of interpersonal, institutional, and structural discrimination in obstetric anesthesia care. Future research should prioritize quantitative analyses between structural discrimination and childbirth pain management, and employ an intersectional approach to improve care for birthing people with multiple marginalized identities. Clinical practice recommendations include developing rapport and trust with birthing people before labor analgesia is needed, diversifying the labor and delivery workforce, establishing patient-family advisory councils, and encouraging professional societies to advocate for equitable perinatal health policies.