“You think, like, you’re neutral but you’re not”: a mixed- methods study of racial/ethnic bias in pain assessment, management and treatment in maternal and newborn care in the Netherlands

Background: Studies indicate racial and ethnic inequities in pain assessment, management and treatment in maternal and newborn care. Namely, racially and ethnically marginalised womxn are less likely to receive pain relief in labour and the post-partum period, and are more likely to experience severe perinatal outcomes such as uterine rupture. This inequity may be explained by racial/ethnic bias in maternal and newborn care professionals’ pain assessment, management and treatment. The aim of this study was to investigate the role of racial/ethnic bias in the assessment, management and treatment of pain among maternal and newborn care professionals in the Netherlands by researching the association between race/ethnicity, language barrier, and response time to pain, and exploring racial thinking and notions of ethnic differences in pain assessment, management, and treatment. Methods: This is a mixed methods study. The quantitative part of this study was a prospective, nationwide population-based cohort study in which cases of uterine rupture were collected through the Netherlands Obstetric Surveillance System (NethOSS), retrospectively investigating the association between categories of race/ethnicity, language barrier, the difference in the response time to pain, and maternal and perinatal outcomes up to 28 days post-partum. The qualitative part was an explorative study to investigate racial and ethnic bias in pain assessment, management and treatment among maternal and newborn care professionals using semi-structured interviews and thematic analysis. Results: The quantitative results indicated that caesarean section was significantly more frequently performed in more than 180 min after the first complaint of pain in the non-Western category compared to the Western category. The qualitative analysis showed the simultaneous presence and unawareness of stereotypes and assumptions about how womxn of different racial/ethnic groups experience and express pain among maternal newborn care professionals. The findings provide insight in how these stereotypes and assumptions affect decision-making about pain assessment, management and treatment. Conclusions: The results of this study provide a starting point to investigate racial and ethnic inequity in maternal and newborn care in the Netherlands, and to address the ways that these differences can be mitigated. Our findings underscore the disavowal of the role of racial thinking and notions of ethnic differences in pain assessment, management, and treatment, and highlights the need for critical reflection on the role of maternal and newborn care in shaping, causing, maintaining, sustaining, and (re)producing racial/ethnic inequity.