Disparities in Postpartum Pain Management After Cesarean Delivery [ID 2683520

Abstract

INTRODUCTION: We evaluated whether postpartum pain management differs by practice setting, ethnicity, insurance, and preferred language in women with cesarean deliveries (CDs). METHODS: This is a retrospective cohort study. Participants who underwent CD at term between 2021 and 2022 were included. Participants with history of opioid use, allergies to NSAIDS, general anesthesia, and postpartum stay greater than 5 days were excluded. The outcomes measures include number of oral “as needed” opioids received measured in morphine milligram equivalents, frequency of pain scores done on the postpartum unit, initial pain scores, pain scores at discharge, and the type and amount of opioids prescribed at discharge. The association of these outcomes based on practice setting (federally funded health center [FFHC] versus private practice [PP]), public versus private insurance, preferred language (English versus non-English), and Hispanic versus Non-Hispanic ethnicity were evaluated. Institutional review board approval was obtained. RESULTS: Four hundred seventy-nine participants were included. FFHCs received less “as-needed” opioids than patients of PP (P=.03). Publicly insured received less opioids than privately insured at discharge (P=.03). English-speaking participants were asked about their pain more frequently (P=.05) and received more inpatient opioids than non-English-speaking participants (P=.00). Non-Hispanic participants were asked about their pain more frequently (P=.042) and were more likely to be discharged with opioid-only medications (P=.04) than Hispanic patients who were discharged with combined medications (P=.03). CONCLUSION: Women attending FFHC, non-English-speaking, with public insurance, and of Hispanic ethnicity experience disparities in postpartum pain management. Targeted protocols should be developed to eliminate the disparities that exist in postpartum pain management.