Wealthy women are far more likely to get an epidural during labour, a major study shows. The UK research highlights stark differences in the pain relief given to different classes. Researchers examined the care given to more than half a million women who gave birth between 2007 and 2020....CONTINUE READING
Of the 593,230 women who gave birth, 131,521 (22.2 per cent) received an epidural for pain relief.
Those from the most affluent areas were 19 per cent more likely to receive an epidural than those from more deprived places, the study found.
The research suggests that women from poorer backgrounds might feel under more pressure to put up with pain, with middle-class women prepared to be more sharp-elbowed.
Researchers said healthcare professionals might treat poorer women differently, with “institutional bias” against those from deprived backgrounds.
The study found an even greater difference among deliveries where there was a clear documented medical indication showing an epidural was necessary.
In such cases, women in the 10 per cent of most affluent areas were 27 per cent more likely to receive pain relief compared to those from the poorest 10 per cent.
NHS watchdogs have warned of widespread failings in maternity care.
Two in three units in England were rated “inadequate” or “requires improvement for safety” in the last ratings by the Care Quality Commission, with major scandals uncovered in Shrewsbury, East Kent and Nottingham.
The study published in Anaesthesia, the journal of the Association of Anaesthetists, was led by the School of Medicine, Dentistry and Nursing, from the University of Glasgow.
It examined NHS data for all women in labour in Scotland between Jan 1 2007 and Oct 23 2020, excluding elective caesarean sections.
Socioeconomic status deciles (groups of 10 per cent from richest to poorest) were defined using the Scottish Index of Multiple Deprivation.
Last month, Victoria Atkins, the Health Secretary, announced £50 million of funding for research to tackle maternal disparities. She said improving maternity services was “personal” to her after her own “frightening” experience of childbirth.
Researchers, led by Dr Lucy Halliday, from the University of Glasgow’s School of Medicine, Dentistry and Nursing suggested women in the poorest groups may be more likely to feel they should put up with pain.
They said: “These women [in the poorest groups] may lack knowledge about indications for epidural analgesia; have life circumstances that may adversely impact antenatal care attendance; mistrust medical staff; feel disempowered during labour; hold misconceptions about epidural safety; or have differing expectations and societal pressures regarding the pain of childbirth.”
“Differences in healthcare professionals’ attitudes and potential institutional and structural biases might also influence the use of epidurals during labour.”
The authors said: “We found that women from areas of greater socioeconomic disadvantage were substantially less likely to receive an epidural for pain relief during labour.
“These results were consistent when the analysis was restricted to births occurring within an inner-city environment with uniform access to obstetric and obstetric anaesthetic services, or when restricted to only include births in women having their first child.”
Previous studies have found that black women are almost four times more likely to die from childbirth than white women.
Maternal death rates in deprived areas are on the rise, with women in the most deprived areas 2.5 times more likely to die than those in the least deprived areas.
A separate study published at the same time in Anaesthesia also shows Asian women in England are more than twice as likely to report severe pain.
The research looked at outcomes following caesarean section deliveries in different ethnic groups, using data from 107 participating obstetric units within the NHS in England during a two-week period in October 2021.
This research by University College London Hospitals London UK and Stanford University School of Medicine included data from 1,000 women who underwent caesarean section delivery with ethnicity and deprivation information provided.
It found that Asian patients had over twice the risk of moderate or severe pain compared to those of white ethnic groups with no differences in pain medication usage, at rest and on movement, respectively.
A Department of Health and Social Care spokesperson said: “The NHS is already one of the safest places to give birth in the world and we are absolutely clear that maternity care must be of the same high standard for everyone.
“NHS England has published guidance for local maternity systems, supported by £6.8 million, focusing on actions to reduce disparities for women and babies from ethnic minorities and those living in the most deprived areas.
“We also set up the Maternity Disparities Taskforce, which brings together experts from across the health system, government departments and the voluntary sector to explore and consider evidence-based interventions to tackle maternal disparities.”
