Women from ethnic minority backgrounds in the UK have different patterns of anaesthesia given during childbirth than do White women, according to a new study based on routinely collected national maternity data for England between 2011 and 2021.
The research, published in Anaesthesia, showed that after adjusting for potential confounders, Black pregnant women in the UK were much more likely than White women to be given general anaesthesia during Caesarean section deliveries. For emergency Caesareans, Black Caribbean-British women were 10% more likely than White women to be given a general anaesthetic.
The researchers, from Cambridge University Hospitals NHS Foundation Trust, London North West University Healthcare NHS Trust, and the National Perinatal Epidemiology Unit at the University of Oxford, said that the reasons for these differences were unknown. However: "There should be further research to see if improvements can made to reduce any inequalities in the different types of pain relief and anaesthesia that women can receive for childbirth."
Their study was based on routinely collected national maternity data for England, hospital episode statistics for admitted patient care between March 2011 and February 2021, which included 2,732,609 births.
Risk of Being Given Anaesthesia Differs by Ethnicity
After adjusting for differences between ethnic groups for maternal age, geographical residence, deprivation, year of delivery, number of previous deliveries, and pre-existing health conditions, including obesity, they found that the increased likelihood of being given general anaesthesia during elective Caesarean births compared with White women was 58% for Black Caribbean-British women and 35% for Black African-British women.
For emergency Caesareans, Black Caribbean-British women were 10% more likely than White women to have been given a general anaesthetic.
In addition, when compared with White women giving birth vaginally, Bangladeshi-British women were 24% less likely to have had an epidural, whilst Pakistani-British women were 15% less likely and Black Caribbean women 8% less likely.
Where the choice came down to assisted vaginal birth (forceps/ventouse delivery) versus emergency Caesarean, Black women were approximately 40% less likely to have an assisted delivery compared with White women.
The authors said: "Ethnic disparities may reflect different cultural attitudes in different ethnic communities and arise from positive maternal preferences and choices. However, 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."
General Anaesthetic Imparts Higher Risk of Adverse Outcomes
The study authors also noted that avoidable general anaesthetics were associated with an increased risk of adverse maternal outcomes, and that general anaesthesia for Caesarean section exposes women to a higher risk of serious medical complications compared with spinal or epidural anaesthetic. The latter are now used for more than 95% of women having a Caesarean in the UK overall, and more than 98% of those having planned, non-emergency Caesareans.
In addition, the quality of recovery is worse after general anaesthetic. Recent research showed that the use of epidural pain relief in labour was associated with less risk of severe complications for the mother, and that babies born to women who had epidural pain relief had a lower risk of adverse childhood developmental outcomes.
The authors said that there were known differences in maternal and neonatal outcomes for women from different ethnic groups in the UK. The maternal death rate in Black women was four times that of White women, they said, and South Asian and Black women had a higher incidence of stillbirth, preterm labour, and foetal growth restriction. Generally, minority ethnic women reported a poorer maternity care experience than White women.
While there was already evidence that ethnic inequalities existed in maternity care in the UK, there had been no previous published study of the relationship between ethnicity and obstetric anaesthetic care in the UK. The authors said that their observational study could not determine the causes for these disparities, which might include "unaccounted confounders". However, they said: "Our findings merit further research to investigate potentially remediable factors such as inequality of access to appropriate obstetric anaesthetic care."
The study was supported by an Obstetric Anaesthetists' Association research grant. JB and DL are members of the Obstetric Anaesthetists' Association executive committee and its Quality and Outcomes subcommittee. MK is Maternal Programme Lead for MBRRACE-UK and JB, DL, and SQ are assessors for MBRRACE-UK maternal mortality and morbidity confidential enquiry. SQ is a subject matter advisor for the Healthcare Safety Investigation Branch. MK is an NIHR Senior Investigator.