‘Je denkt dat je neutraal bent, maar dat ben je niet’: Raciale en etnische vooroordelen over pijn in de Nederlandse geboortezorg

OBJECTIVE: 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. DESIGN: Mixed methods study. METHOD: Quantitative: retrospective assessment of a prospective cohort of uterine ruptures in the Netherlands (NethOSS, 2016-2018) examining associations between race/ethnicity categories and language barrier, and the response time to pain and maternal/perinatal outcomes. Qualitative: thematic analysis of semi-structured interviews with professionals about racial and ethnic bias in pain assessment, management and treatment. RESULTS: Caesarean section was significantly more frequently performed >180 minutes after the first pain complaint in the non-Western category compared to the Western category (8/15 (53.3%)) vs (1/12 (8.3%))) (OR 12.57, 95% CI 1.28- 123.48). Professionals expressed implicit racial and ethnic bias and stereotypes about pain experience and expression, while mostly perceiving their own practice as unbiased. CONCLUSION: Racial thinking and notions of ethnic differences in pain assessment, management, and treatment were largely unrecognized.