Nov 1, 2022 - Health

Anesthesia use disparities could negatively affect Black maternal health, experts say

Illustration of a hospital emergency room with different colored shapes around it.

Photo illustration: Brendan Lynch/Axios. Photo: Linh Ta

New research showing racial disparities in regional anesthesia use has major implications for Black women — especially in pregnancy and childbirth, medical experts and reproductive health advocates tell Axios.

Why it matters: Black women have a long history of experiencing medical maltreatment, the legacy of which remains today in implicit biases and systemic inequities that worsen health outcomes. They are three times more likely to die from pregnancy-related complications compared to white women, according to the Centers for Disease Control and Prevention.

Driving the news: A new study, which reviewed the records of nearly 57,000 adults who had surgery between 2016 and 2021, found that people of color were 29% less likely to receive regional anesthesia compared to white patients.

  • Patients with Medicaid insurance were 39% less likely to receive regional anesthesia than those with private insurance.
  • Women were 11% less likely to receive regional anesthesia than men.

The big picture: The finding that Black women are less able to access anesthesia has particularly dangerous consequences in pregnancy and childbirth, one of the most painful and oft life-threatening operations in medicine.

  • Black women have a 53% increased risk of dying in the hospital during childbirth compared to white women — no matter their income level, type of insurance or other social determinants of health, according to another recent survey that analyzed 9.5 million hospital deliveries between 2007 and 2018.
  • Anesthesia is "really interwoven with obstetrics ... Epidurals provide great pain relief when they work and also when people get C-sections," Alexander Beletsky, resident physician at the Riverside Community Hospital and the lead author of the anesthesia study, told Axios.
  • Researchers have also shown that the use of epidurals in childbirth is associated with a decreased risk of severe maternal morbidity.

Between the lines: The maternal health care system in the U.S. has long failed Black women, according to Jamila Perritt, an obstetrician-gynecologist who heads the group Physicians for Reproductive Health.

  • J. Marion Sims, who is often called the "father of modern gynecology," repeatedly experimented on enslaved women without anesthesia in the 1800s, spurred by racist beliefs that Black people have a higher tolerance for pain.
  • A 2016 study found that roughly half of the medical trainees surveyed endorse the same kind of false beliefs about biological differences between Black and white people.

What they're saying: "There's an emerging amount of evidence pointing at implicit biases that providers may have and how that may affect ... particular regions or areas of care like obstetrics," Beletsky added.

  • Nobody should be expected to go through these procedures without anesthesia, Venicia Gray, senior manager for maternal and infant health at the nonprofit National Partnership for Women & Families, told Axios.
  • Both studies, which were recently presented at the American Society of Anesthesiologists' 2022 annual meeting, "just compound on the result of systemic racism that leads people to accept any number of false racial stereotypes," Gray said.
  • "With this maternal health crisis, there are really some strategies that remain largely overlooked, and that includes adequately and intentionally addressing the structurally based inequities of unmet social needs and really working to dismantle the racism and the misogyny, frankly, that drive them."

Worth noting: The fall of Roe will likely increase maternal mortality rates, said Robert White, an anesthesiologist at Weill Cornell Medicine and the lead author of the study that analyzed hospital deliveries.

  • States with more restrictive abortion policies already have higher maternal mortality ratios, higher racial disparities in public funding for maternal care and fewer social safety nets like Medicaid expansion or paid leave, according to White.
  • "So at the end of the day, it's: how do you want to die?" Gray said. "Which is a scary, terrible thing to say. But that's kind of the stark reality."

Something to watch: More people are turning to home births, birthing centers, doulas and midwives in a bid to avoid discrimination in hospital settings, and that trend will likely continue, Gray noted.

Go deeper: White House issues first-ever proclamation on Black maternal health

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