Advocating for Equitable Postpartum Pain Management for Black Mothers

beachcopeland
9 minutes ago
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In the childbirth cycle, the postpartum period begins after a woman gives birth and extends through the first 12 weeks after delivery. During this time, mothers recover from childbirth and may experience varying levels of uterine, perineal, abdominal incision, and breast pain (American College of Obstetricians & Gynecologist [ACOG], 2020). Researchers have found that Black women in the United States experience greater disparities in postpartum pain management compared to White women (Badreldin et al., 2019; Craig et al., 2025). In addition, researchers at Cedars-Sinai (2024) reported that Black women often had difficulty caring for themselves and their infants because of uterine or cesarean incision pain. These researchers also found that Black women received lower doses of postpartum pain medication than White women.

It is imperative that healthcare professionals (HCPs) conduct frequent and comprehensive postpartum pain assessments that actively involve mothers in describing their pain experiences and utilize standardized pain assessment tools throughout the postpartum period.

Clinical Burden of Postpartum Pain

Common sources of postpartum pain include:

Uterine Contraction Pain: Commonly referred to as “afterpains,” which occur as the uterus involutes and returns to its pre-pregnancy size after birth.
Perineal Pain: Women who experience episiotomies or perineal tears are at increased risk for perineal pain. However, discomfort may also occur even without visible lacerations.
Breast Pain: For lactating mothers, breast pain can interfere with breastfeeding. Common causes include blocked ducts, mastitis, and nipple blisters.
Incisional Pain After Cesarean Birth: Pain following a cesarean section may interfere with mobility, infant bonding, and breastfeeding (Zhou et al., 2025).
Mental Health Concerns: Black women experience higher rates of postpartum depression, anxiety, and suicidal ideation compared to White women (Black Maternal Mental Health Issue Brief, May 15, 2026).

Effective treatment of postpartum pain is essential because unmanaged pain can interfere with a mother’s ability to care for herself and her infant. Untreated pain may delay recovery and increase the risk of prolonged opioid use, persistent pain, and postpartum depression in mothers (ACOG, 2021; Cedars-Sinai, 2024; Craig et al., 2025; Hoang, T. M., H. et al., 2023).

Racial Disparities in Pain Care

Multiple studies have shown that Black postpartum women report higher pain scores than White women (Craig et al., 2025; Green et al., 2023; Harkins et al., 2025). Despite this, Black women consistently receive lower quantities of inpatient analgesics, particularly opioid medications, compared to White patients.

Furthermore, Green and colleagues (2023) found that the use of standard pain order sets did not significantly reduce Black mothers’ pain levels. These findings suggest that more equitable and individualized postoperative pain management strategies are needed to reduce pain disparities experienced by Black mothers during the early postpartum period.

Pharmacological Treatment for Postpartum Pain

Obstetricians and other obstetric HCPs should use a stepwise, multimodal approach when prescribing pain medication for postpartum patients. For women who have vaginal deliveries, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, are typically recommended as first-line treatment for postpartum pain. Opioids should be considered only when pain remains inadequately controlled, and mothers should be counseled about potential central nervous system (CNS) depressive effects for both themselves and their infants.

For postoperative cesarean pain, HCPs also use a stepwise multimodal approach that may include oral and parenteral analgesics administered intramuscularly or intravenously. Commonly used medications include acetaminophen, NSAIDs, and opioids (ACOG, 2021). Breastfeeding mothers may receive intravenous or intramuscular ketorolac (Toradol) for short-term pain relief during the first five postpartum days (ACOG, 2021).

Women who undergo cesarean births may experience more breakthrough pain and may require opioids for acute pain management. However, the combination of NSAIDS, acetaminophen, and short-acting opioids is usually effective for controlling cesarean pain and should be used first as first-line treatment before progressing to stronger opioids for breakthrough pain (ACOG, 2021).

Overall, postpartum pain management should be individualized according to the birth, maternal-comorbidities, and patient preferences (ACOG, 2021). Because no single strategy adequately addresses the pain management needs of all individuals, the use of shared decision-making algorithms between patients and clinicians is recommended to promote equitable and effective postpartum pharmacological treatment (ACOG, 2021).

Racial and Ethnic Disparities in Postpartum Pain Management

Why do Black mothers often receive different levels of postpartum pain management than White mothers? In the United States, racism remains a major driving force behind racial and ethnic disparities in healthcare access and outcomes (Craig et al., 2025; Harkins et al., 2025). Racism in healthcare can be categorized into three major forms:

Structural Racism: Societal systems, such as housing, education, and insurance policies, that create and maintain inequities.
Institutional Racism: Discriminatory policies and practices embedded within healthcare organizations and systems.
Interpersonal Racism: Explicit discrimination and implicit bias that influence patient-provider interactions and clinical decision-making.

Disparities in analgesic administration raise serious concerns about equity in clinical care. Inadequate pain management may also lead postpartum women to mistrust healthcare professionals, potentially affecting their engagement in future obstetric visits and the healthcare system overall (Craig et al., 2025).

What Equitable Care Should Look Like

Healthcare professionals must provide equitable, patient-centered care to all postpartum patients. Examples of equitable postpartum pain management include:

Using standardized and consistent pain assessments at defined intervals.
Validating and clearly documenting self-reported pain.
Avoiding assumptions based on race, age, or parity.
Ensuring multimodal pain management and comprehensive discharge teaching.
Providing reliable follow-up care for women with persistent or worsening pain.
Offering patient-centered counseling and educational resources related to postpartum pain.
Creating opportunities for questions by asking, “Do you have any questions or concerns?”
Listening actively and validating patient concerns.
Reflecting on how implicit bias may influence interactions with patients.
Providing respectful, person-centered care.
Participating regularly in equity-focused education and training (Badreldin et al., 2019; Craig et al., 2025; Harkins et al., 2025; Hoang et al., 2023; Nurse.com).

Physicians, nurses, anesthetists, and other healthcare professionals are in key positions to advocate for and improve Black women’s postpartum health experiences.

Summary

Black mothers in the United States often experience greater postpartum pain but receive less adequate pain treatment than White mothers. Healthcare professionals must provide equitable, patient-centered care through standardized pain assessment, individualized treatment, and efforts to reduce racial bias in postpartum care.

References

American College of Obstetricians & Gynecologist. (2020). Postpartum pain management. https://www.acog.org/womens-health/faqs/postpartum-pain-management

American College of Obstetricians & Gynecologist. (2021). Pharmacological stepwise multimodal approach for postpartum pain management. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/09/pharmacologic-stepwise-multimodal-approach-for-postpartum-pain-management

Badreldin, N., Grobman, W. A., Yee, L. M. (2019). Racial disparities in postpartum management. Obsterics & Gynecology, 136(6), 1147-1153. https://pubmed.ncbi.nlm.nih.gov/31764723/

Cedars-Sinai.org. (Jul 9, 2024). Black and Hispanic women receive lower doses of postpartum pain medication, according to new study. https://www.cedars-sinai.org/newsroom/black-and-hispanic-women-receive-lower-doses-of-postpartum-pain-medication-according-to-new-study/

Craig, R., Nour, S. E., Blake, L., Carvalho, B., Kua, J., & O’Carroll, J. E. (2025). Racial and ethnic disparities in postpartum pain: A systematic review. International Journal of Obstetric Anesthesia, 64. https://pubmed.ncbi.nlm.nih.gov/40714536/

Green, C. A., Johnson, J. D., McKenzie, C., & Stuebe, A. (2023). Standardized order sets do not eliminate racial or ethnic inequities in postpartum management. Health Equity, 7:1, 685-691. https://pmc.ncbi.nlm.nih.gov/articles/PMC10615045/

Harkins, S. E., Hazi, A. K., Guglielminotti, J., Landau, R., & Barcelona, V. (2025). Discrimination, racism, and bias in childbirth pain management in the United States: A scoping review and directions for research and clinical care. Internal Journal of Obstetric Anesthesia, 63:104379. https://pubmed.ncbi.nlm.nih.gov/40349529/

Hoang, T. M. H., Lee, B. A., Hsieh, W. J., Lukacena, K. M., & Tabb, K. M. (2023). Experiences of racial trauma among perinatal women of color in seeking healthcare services. General Hospital Psychiatry, 84, 60-66. https://doi.org/10.101016/j.genhosppsych.2023.06.015

Lynch, M. (5/18/2025). From awareness to action: Advancing equity in Black maternal healthcare. Nurse.com. https://www.nurse.com/blog/advancing-equity-in-black-maternal-healthcare/

Policy Center for Maternal Mental Health. (12/8/2023). Black maternal mental health issue brief. https://policycentermmh.org/black-maternal-mental-health-issue-brief/

Zhou, L., Li, J., Zhou, Y., Liang, Y., Ma, Quigling, Yang, Luyao, Pang, Y., Fang, Y., & Guo, Y. (2025), Pain Management for postpartum Pain: A narrative review. Journal of Pain Research, 18, 5617-5626. Pain Management for Postpartum Pain: A Narrative Review - PubMed

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