Racial and Ethnic Differences in Postpartum Pain and Opioid Consumption after Cesarean Delivery

Abstract

Background:

Retrospective studies suggest that Black and Hispanic patients may experience greater postpartum pain and receive fewer analgesic medications after cesarean delivery compared with Asian and White patients. This study prospectively investigated racial and ethnic differences in postpartum pain and opioid consumption.

Methods:

In this prospective, observational study conducted from 2018 to 2021, women scheduled for cesarean delivery completed validated psychological and pain questionnaires. On postoperative days (PODs) 0–2, nurses assessed pain (0–10) and administered opioid analgesics as needed. Average and maximal pain severity scores across PODs 0–2 were calculated. Administered opioid doses were converted to morphine milligram equivalents and normalized per hour (MME/hour) across PODs 0–2. Analyses of covariance examined racial and ethnic differences in postpartum pain and opioid consumption, controlling for maternal age, body mass index, preoperative pain severity, cesarean delivery type, and surgical duration.

Results:

Patients (N = 641) identified as African American (n = 67, 10.5%), Asian (n = 38, 5.9%), Hispanic/Latina (n = 64, 10%), and White (n = 472, 73.6%). No significant racial or ethnic differences were observed in preoperative psychological factors, including anxiety, depression, and pain catastrophizing. African American and Hispanic/Latina patients experienced greater postpartum pain and received higher opioid doses (MME/hour) than Asian and White patients.

Conclusion:

Substantial variability in postpartum pain was observed within each racial and ethnic group, highlighting the importance of factors beyond race and ethnicity that may modulate pain. Given the lack of significant differences in psychological factors assessed, future research should investigate additional psychosocial factors (e.g., experiences of discrimination) and resilience factors (e.g., optimism) that may help identify targets for intervention.

Introduction

Cesarean delivery is one of the most common surgical procedures performed globally, with over 1.2 million cases performed annually in the United States alone. ¹ In 2021, in the United States, Black patients had the highest cesarean delivery rate (36.8%), compared with 33.1% of Asian, 31.6% of Hispanic, and 31% of White patients. ¹ Perioperative pain is a significant concern for women undergoing cesarean delivery, as it is associated with greater opioid use and postpartum depression, delayed functional recovery, and the development of chronic pain. Chronic pain disproportionally burdens Black, Indigenous, and people of color, ² and Black and Hispanic patients tend to experience more severe pregnancy-related pain than White patients, ³ potentially increasing their risk for greater postpartum pain and opioid exposure. While approximately 20% of patients report moderate to severe postpartum pain, and studies have demonstrated racial and ethnic inequities in perinatal morbidity and mortality, ⁴ less work has focused specifically on inequities in postpartum pain experiences.

Retrospective studies of U.S. patients have suggested that Black and Hispanic patients experience greater pain after cesarean delivery than Asian and White patients.^5–9 Despite this, although not uniformly observed,^7,10 White patients have been shown to receive more analgesic medications, including opioids, compared with Asian, Black, and Hispanic patients.^5–7,9 Most prior studies have been retrospective in nature and have lacked comprehensive, validated assessments of preoperative pain and psychological characteristics. The ability to prospectively assess and account for these patient-level pain modulatory characteristics prior to cesarean delivery is crucial for understanding racial and ethnic inequities in postpartum outcomes and for identifying potential interventional targets to reduce these inequities.

The present study prospectively investigated racial and ethnic differences in postpartum pain and opioid consumption during the acute postoperative period among African American, Asian, Hispanic/Latina, and White women undergoing cesarean delivery.

Methods

Participants and procedure

Women scheduled for cesarean delivery were recruited for this prospective, observational study at Brigham and Women’s Hospital in Boston, MA, USA, between October 2018 and April 2021 (Fig. 1). Eligible patients had a singleton pregnancy with a gestational age >36 weeks, were aged 18–50 years, and were proficient in English. Exclusion criteria included planned hysterectomy, vertical skin incision, and contraindication for neuraxial anesthesia. Written informed consent was obtained on the day of the cesarean delivery, followed by the completion of demographic, clinical pain, and psychological questionnaires. Postoperatively, nurses assessed patients’ pain multiple times daily. Nonopioid analgesics were administered per protocol, and opioid analgesics were given as needed. All pain scores and analgesic administrations were extracted from the electronic medical record. Study procedures were approved by the Partners Human Research Committee/Institutional Review Board.

FIG. 1.

Study flow chart.

The present study was part of a larger project evaluating how different lengths of preoperative psychological questionnaires explain variability in postpartum pain and opioid consumption after cesarean delivery. However, that project did not explore racial or ethnic differences in pre-, peri-, or postoperative factors. ¹¹ As the present study focused on racial and ethnic differences in postpartum pain and opioid consumption during the acute postoperative period, while accounting for group differences in relevant pre- and perioperative factors, it does not overlap with previously published results from the parent study.

Preoperative questionnaires

Pain

Baseline pain during the week prior to cesarean delivery was assessed using the validated and reliable Brief Pain Inventory (BPI). ¹² All four items (current pain, average, least, and worst pain over the past week) were rated on a scale from 0 (no pain) to 10 (worst pain imaginable) and averaged for a total pain severity score (range: 0–10).

Psychological factors

Depression, anxiety, and sleep disturbance during the week prior to cesarean delivery were assessed using the reliable and valid Patient-Reported Outcomes Measurement Information System short forms. ¹³ Raw scores were converted to standardized T-scores (mean of 50 points with standard deviation of 10 points). ¹³ The Pain Catastrophizing Scale is a reliable and valid measure used to assess rumination, magnification, and helplessness related to pain. ¹⁴

Demographic and medical characteristics

Patients self-reported their age, height, weight, and body areas where they experienced pain over the past week. They also self-identified their race and ethnicity by selecting from eight categorical options: (1) African American, (2) Asian, (3) Hawaiian/Pacific Islander, (4) Hispanic/Latina, (5) Native American, (6) White, (7) mixed race, and (8) other. Gestational age and whether the cesarean delivery was primary or repeat were extracted from the electronic medical record.

Perioperative care

Procedural pain assessment

Immediately prior to spinal or epidural needle insertion, patients received a 2.5 mL injection of 1% lidocaine via a 25-gauge needle to anesthetize the skin and subcutaneous tissues at the L3–4 or L4–5 vertebral interspace. Patients were intentionally not informed about the amount of pain to expect with the skin injection and were asked immediately afterward to rate their pain from the injection (0 = no pain, 10 = worst pain imaginable). This local anesthetic injection is a standard procedure and serves as a “bedside” test of patients’ pain processing, analogous to the application of standardized painful stimuli used in formal experimental quantitative sensory testing to assess differences in patients’ psychophysical characteristics.^11,15,16

Perioperative analgesic administration

Cesarean delivery was performed under single-injection spinal or combined spinal epidural anesthesia (CSE) at the L3–4 or L4–5 vertebral interspace, using 0.75% hyperbaric bupivacaine (typically 1.6–1.8 mL), fentanyl (10–20 mcg), and morphine (100–200 mcg). The choice between CSE and spinal anesthesia was at the provider’s discretion, usually based on the anticipated duration of the surgery. Patients receiving CSE initially receive the same spinal anesthetic agents and doses, with supplemental agents administered via the epidural catheter as needed.

Postoperative assessments

Average and maximal pain severity

Pain (0 = no pain, 10 = worst pain imaginable) was assessed by nurses on a routine schedule, at least every 4 hours, on the day of and during the first 2 days following cesarean delivery. Additionally, pain was intermittently assessed as part of clinical care, such as before and after analgesic administration.

A daily average pain severity score was calculated for postoperative day 0 (POD0: end of surgery to midnight), POD1 (midnight to midnight), and POD2 (midnight to midnight or midnight to discharge) by averaging all the pain scores recorded during that time period. The highest pain score on each POD was also extracted as the daily maximal pain severity score. Grand averages of both average pain and maximal pain across PODs 0–2 were created to enable group comparisons over the entire acute postoperative period.

Postoperative analgesic administration

Postoperative pain at our institution was managed with a scheduled regimen of nonopioid analgesics, while opioids were available on an as-needed basis. During the first 24 hours after cesarean delivery, patients received intravenous (IV) ketorolac (30 mg every 6 hours) and oral acetaminophen (975 mg every 6 hours). Afterward, scheduled oral acetaminophen was continued, and IV ketorolac was typically replaced by scheduled oral ibuprofen (600 mg every 6 hours). Opioid analgesics included oral hydromorphone (2–4 mg), oral oxycodone (5–10 mg), or IV hydromorphone (0.2–0.4 mg), available every 4 hours as needed. All opioid administration was documented by POD from the electronic medical record, converted to morphine milligram equivalents (MMEs), divided by the number of hours in that POD, and expressed as MME per hour (MME/hour).

Data analysis

Descriptive data are presented as means and standard deviations for continuous variables and as percentages for categorical variables. Analyses of variance and chi-square tests were used to examine racial and ethnic differences in pre- and perioperative patient characteristics. Analysis of covariance (ANCOVA) models assessed racial and ethnic differences in postpartum pain (average and maximal pain across PODs 0–2) and opioid consumption (MME/hour), controlling for maternal age, body mass index (BMI), preoperative BPI pain severity, cesarean delivery type (primary = 0 versus repeat = 1), and surgical duration. Between-group effect sizes for ANCOVAs were calculated using partial eta squared (η_p²), with small, medium, and large effects defined as 0.01, 0.06, and 0.14, respectively. ¹⁷ Post hoc comparisons were conducted as appropriate to determine pairwise differences between racial and ethnic groups. A post hoc power analysis indicated that a sample of 641 patients was sufficient to detect small effect sizes on postpartum pain (η_p² = 0.03) with 80% power at α = 0.05. Data analysis was performed using SPSS Statistics v29 (IBM).

Results

Patient Characteristics

Of 642 women who participated in the study, 10.4% (n = 67) identified as African American, 5.9% (n = 38) as Asian, 10% (n = 64) as Hispanic/Latina, and 73.5% (n = 472) as White. One patient who identified as mixed race was excluded from the current analysis. Patients had a mean age of 34.3 years (SD = 4.4), an average BMI of 32.0 (SD = 6.3), and a mean gestational age of 38.7 weeks (SD = 1.0). Most patients (66%) were undergoing a repeat cesarean delivery.

Significant differences were observed between racial and ethnic groups in maternal age, BMI, and incidence of previous cesarean delivery (Table 1). African American and Hispanic/Latina patients were younger than Asian patients, and Hispanic/Latina patients were also younger than White and African American patients. African American and Hispanic/Latina patients had higher BMIs than Asian and White patients. Additionally, a greater proportion of African American patients were undergoing repeat cesarean delivery compared with other groups, while a higher proportion of Asian patients were undergoing primary cesarean delivery (Table 1).

Table 1.

Racial and Ethnic Differences in Preoperative Patient Characteristics and Perioperative Care

	African American (n = 67)	Asian (n = 38)	Hispanic/Latina (n = 64)	White (n = 472)
	Mean ± SD or n (%)	Mean ± SD or n (%)	Mean ± SD or n (%)	Mean ± SD or n (%)	p Value
Preoperative Characteristics
Agea,b,e,f	33.8 ± 5.4	35.6 ± 3.4	30.3 ± 4.7	34.8 ± 4.0	<0.001
BMIa,b,c,d,e	34.5 ± 6.9	29.1 ± 5.4	35.4 ± 7.2	31.4 ± 5.9	<0.001
Primary cesarean delivery	14 (21%)	20 (53%)	22 (34%)	160 (34%)	0.012
BPI Pain Severity (range: 0–10)a,b,d,e	1.9 ± 1.8	0.9 ± 1.1	1.6 ± 2.0	1.2 ± 1.3	<0.001
Depression (range: 0–100)	41.1 ± 6.9	42.7 ± 6.9	41.8 ± 7.4	41.7 ± 6.1	0.673
Anxiety (range: 0–100)	48.8 ± 10.4	50.0 ± 9.1	48.7 ± 10.9	50.6 ± 8.5	0.231
Sleep disturbance (range: 0–100)	53.8 ± 8.6	53.7 ± 7.9	56.1 ± 10.3	55.7 ± 7.8	0.180
Pain catastrophizing (range: 0–52)	9.9 ± 9.6	9.4 ± 7.4	7.4 ± 8.0	8.4 ± 8.6	0.349
Perioperative Care
Pain during local anesthetic injectionb,d,e	3.8 ± 2.3	3.0 ± 2.0	4.0 ± 2.2	3.0 ± 1.9	<0.001
Anesthetic type					<0.001
Spinal	42 (63%)	37 (97%)	46 (72%)	399 (84.5%)
Epidural	—	—	2 (3%)	—
Combined spinal epidural	25 (37%)	1 (3%)	16 (25%)	73 (15.5%)
Surgical duration (minutes)a,b,d,e	63.4 ± 21.3	52.0 ± 12.1	66.1 ± 22.1	55.5 ± 15.0	<0.001

p-values are presented as raw values, with those less than 0.05 bolded to indicate statistical significance.

ANOVAs were conducted for continuous variables and chi-square tests for categorical variables.

^asignificant difference between African American and Asian.

^bsignificant difference between Asian and Hispanic/Latina.

^csignificant difference between Asian and White.

^dsignificant difference between African American and White.

^esignificant difference between Hispanic/Latina and White.

^fsignificant difference between African American and Hispanic/Latina.

BMI, body mass index; ANOVA, analysis of variance; BPI, Brief Pain Inventory.

Pre- and Perioperative Assessments

During the week prior to cesarean delivery, patients reported an overall average BPI pain severity score of 1.3/10 (SD = 1.4, range: 0–7.5), with pain most commonly reported in the lower back (41%), abdomen (34%), and hips (24%). Patients had average T-scores of 41.7 for depression, 50.2 for anxiety, and 55.4 for sleep disturbance. Based on general population means (with a score of 50 representing the average), these T-scores were not considered clinically elevated. ¹³ African American and Hispanic/Latina patients reported significantly higher preoperative pain severity compared with Asian and White patients, but no significant group differences were observed in preoperative depression, anxiety, sleep disturbance, or pain catastrophizing (Table 1).

African American and Hispanic/Latina patients also experienced significantly greater pain from the subcutaneous local anesthetic injection compared with White patients, and Hispanic/Latina patients experienced greater pain from the injection compared with Asian patients (Table 2). Most patients received spinal anesthesia (81.7%), while 0.3% received epidural anesthesia, and 18% received combined spinal epidural (CSE) anesthesia. Patients receiving CSE (n = 115) initially received the same spinal anesthetic agents and doses, with a small subset (n = 6, 14%) receiving supplemental 2% lidocaine later during surgery. The average duration of cesarean delivery was 57.2 minutes (SD = 16.9), with significantly longer surgeries among African American and Hispanic/Latina patients compared with Asian and White patients (Table 1).

Table 2.

Racial and Ethnic Differences in Postoperative Pain and Opioid Consumption

	African American (n = 67)	Asian (n = 38)	Hispanic/Latina (n = 64)	White (n = 472)
	Mean ± SD or n (%)	Mean ± SD or n (%)	Mean ± SD or n (%)	Mean ± SD or n (%)	F	p Value	ηp2
Number of Pain Scores	30.6 ± 0.8 (29.1–32.2)	28.3 ± 1.1 (26.2–30.4)	29.7 ± 0.8 (28.1–31.4)	28.6 ± 0.3 (28.0–29.2)	2.2	0.08	0.01
Average Paina,b,c,d	3.3 ± 0.1 (3.0–3.6)	2.6 ± 0.2 (2.2–2.9)	3.2 ± 0.1 (2.9–3.5)	2.7 ± 0.1 (2.6–2.8)	8.0	<0.001	0.04
Maximal Paina,b,c,d	5.8 ± 0.2 (5.4–6.1)	4.8 ± 0.3 (4.3–5.3)	5.6 ± 0.2 (5.2–5.9)	4.8 ± 0.1 (4.7–5.0)	9.0	<0.001	0.04
Opioid Consumption (MME/hour)a,b,c,d	0.5 ± 0.1 (0.3–0.6)	0.2 ± 0.1 (0.0–0.4)	0.5 ± 0.1 (0.4–0.7)	0.3 ± 0.0 (0.2–0.3)	4.7	0.003	0.02

p-values are presented as raw values, with those less than 0.05 bolded to indicate statistical significance.

ANCOVAs controlling for maternal age, BMI, primary versus repeat cesarean delivery, preoperative BPI pain severity, and surgical duration.

^aSignificant difference between African American and Asian.

^bSignificant difference between Asian and Hispanic/Latina.

^cSignificant difference between African American and White.

^dSignificant difference between Hispanic/Latina and White.

ANCOVA, analysis of covariance; BMI, body mass index; BPI, Brief Pain Inventory; MME/hour, morphine milligram equivalents per hour; SE, standard error; CI, confidence interval.

Postpartum Pain and Opioid Consumption

No differences were observed in the total number of postoperative pain assessments, with an average of 29 pain scores recorded per patient (range: 15–70). Daily average and maximal pain severity scores (Fig. 2) were variable across the acute postoperative period. Grand averages across PODs 0–2 showed an average pain severity of 2.8 (SD = 1.1, range: 0.4–7.0) and a daily maximum pain score of 5.0 (SD = 1.6, range: 1.3–10.0). Among all patients, the average opioid dose administered across PODs 0–2 was 0.3 MME/hour (SD = 0.6, range: 0.0–5.6).

FIG. 2.

Racial and ethnic differences in (A) average and (B) maximal postoperative pain across PODs 0–2. PODs, postoperative days.

ANCOVAs revealed that African American and Hispanic/Latina patients experienced significantly higher levels of both average and maximal postpartum pain compared with Asian and White patients (Fig. 2, Table 2). Similarly, African American and Hispanic/Latina patients received significantly greater opioid doses (MME/hour) than Asian and White patients (Fig. 3, Table 2). Minor and inconsistent racial and ethnic differences were observed in the administration of nonopioid analgesics (Supplementary Data). A sensitivity analysis revealed that the pattern and significance of findings (greater postpartum pain and MME/hour among African American and Hispanic/Latina patients compared to Asian and White patients) remained unchanged after adjusting for total nonopioid analgesic use across PODs 0–2.

FIG. 3.

Racial and ethnic differences in postoperative opioid consumption (MME/hour). MME, morphine milligram equivalents.

Discussion

This prospective analysis of women undergoing cesarean delivery found that African American and Hispanic/Latina patients experienced greater postpartum pain and received higher opioid doses (MME/hour) than Asian and White patients during the acute postoperative period. These differences persisted even after controlling for preoperative pain and other relevant pre- and perioperative factors. Our findings highlight the need for future prospective research into psychosocial factors underlying racial and ethnic disparities in postpartum pain experiences. Such work can inform the development and implementation of culturally tailored, personalized peripartum interventions aimed at improving maternal health, particularly among African American and Hispanic/Latina patients who may be at greater risk for adverse outcomes.

Consistent with studies in other patient populations using quantitative sensory testing (QST) procedures, ¹⁸ we found that African American and Hispanic/Latina patients experienced greater pain sensitivity in response to a relatively standardized pain stimulus (i.e., the local anesthetic injection) compared with Asian and White patients. Pain response to the local anesthetic injection may serve as a practical bedside measure of nociceptive processing. While retrospective studies have reported that African American and Hispanic patients experience worse postpartum pain than Asian and White patients,^5–9 our study extends prior work by incorporating comprehensive, prospective, and validated assessments of pain, known psychological modulators, as well as surgical and anesthetic factors. We observed that African American and Hispanic/Latina patients experienced more severe postpartum pain compared with Asian and White patients, and these differences persisted after controlling for preoperative pain and other relevant factors. Importantly, substantial variability in postpartum pain was observed within each racial and ethnic group (much greater than between groups), underscoring the role of factors beyond race and ethnicity in modulating pain. This variability highlights the multifactorial nature of pain, which is crucial to recognize for the implementation of personalized analgesia. ¹⁹

Researchers have speculated that racial and ethnic differences in postpartum pain may stem from inequities in analgesic medication administration. Although findings regarding racial and ethnic differences in postpartum opioid administration are somewhat mixed,^5,8–10 most studies suggest that African American, Asian, and Hispanic patients receive less or similar amounts of opioids compared with White patients. In contrast, our study found that African American and Hispanic/Latina patients received more opioids than Asian and White patients. While the observed differences in opioid consumption were modest, likely due to the large proportion of patients receiving minimal or no opioids, our findings suggest that these slightly higher opioid doses were insufficient to reduce pain scores among African American and Hispanic/Latina patients to levels comparable with Asian and White patients. Although opioids remain a common tool for postoperative pain management, reducing peripartum opioid exposure is important due to potential adverse effects. Opioid-induced hyperalgesia, which can develop even after brief exposure, may worsen postsurgical pain during the subacute phase.^20,21 Additionally, substantial variability in maternal and neonatal drug clearance means that opioid transfer through breast milk, although typically small, can accumulate. ²²

While we did not observe racial or ethnic differences in preoperative psychological factors such as depression, anxiety, catastrophizing, or sleep disturbance, other psychosocial factors that were not assessed warrant further investigation. For example, beyond general psychological distress, pregnancy-specific distress (e.g., anxiety related to pregnancy, labor, or delivery, or trauma from prior pregnancy experiences) may be particularly relevant. Additionally, Black and Hispanic individuals are more likely to experience other chronic stressors, including adverse childhood experiences, discrimination, and racism-based traumatic stress.^2,23 As these psychosocial factors have shown to contribute to pain disparities in non-obstetric populations, ² it is plausible that they may also play a significant role in postpartum pain outcomes. Furthermore, research suggests that the relationship between resilience factors (e.g., positive affect, optimism) and pain may differ across racial and ethnic groups. ²⁴ Thus, future studies should also explore potential protective factors that may help reduce postpartum pain and improve recovery.

Treatments for managing pain, including enhanced recovery after cesarean delivery (ERAC) protocols, must be personalized to each patient. This personalization should incorporate, but not be limited to, racial and ethnic identity, and also consider preoperative pain sensitivity and psychosocial factors. Studies investigating the efficacy of patient-centered approaches, such as personalized ERAC protocols, are needed to help address these disparities. Nonpharmacological treatment approaches may reduce both pain and opioid exposure, and there is growing evidence supporting their efficacy in postsurgical pain management. For example, preoperative behavioral interventions, such as cognitive behavior therapy and psychoeducation, have been shown to reduce pain both before and after surgery in several surgical populations.^25–27 However, evidence for these interventions in obstetric populations remains limited. A holistic approach that integrates an understanding of individual risk and resilience factors ²⁴ may help inform the development and implementation of culturally adapted and personalized peripartum interventions to improve maternal health outcomes.

Limitations and Future Directions

This study has several strengths, including its prospective design, comprehensive data collection, and use of validated assessments of preoperative pain and psychological factors. Nonetheless, there are limitations that should be acknowledged and addressed in future research. Although we assessed key psychological factors, our ability to examine broader psychosocial contributors and social determinants of health, such as educational attainment and socioeconomic status, was limited. These factors may help understand racial and ethnic disparities in postpartum outcomes and should be explored in future work. While using all available pain scores provided a comprehensive view of postoperative pain, scores were not tied to standardized time points and were not collected by a single assessor, which may introduce some variability in measurement.

Participants were required to select their race and ethnicity from predetermined, combined categories, which did not allow for separate identification of race and ethnicity or for multiracial or multiethnic identities (e.g., selecting both White and Hispanic/Latina). Future studies should follow recently published guidelines on racial and ethnic data collection and terminology. ²⁸ Our sample was predominantly White, with smaller representation from African American, Asian, and Hispanic/Latina groups. This imbalance may reduce the generalizability of findings and limit statistical power to detect within- and between-group differences. Additionally, we were unable to collect racial and ethnic data from individuals who declined participation, limiting our ability to assess potential selection bias.

In our sample, African American and Hispanic/Latina patients had higher BMIs, and more African American patients had repeat cesarean deliveries. Since higher BMI and repeat cesarean deliveries are both linked to longer surgery times,^29,30 these factors may help explain the longer surgical durations observed in these groups. Although trainee involvement may also influence surgical duration, fellows and residents routinely participate in all cases at our teaching hospital under the direct supervision of a scrubbed attending surgeon. However, we did not collect detailed data on trainee type and experience, which represents another possible limitation. Additionally, other clinical factors that may influence postoperative pain, such as substance or alcohol use history and preexisting medical conditions, were not assessed. Future studies should incorporate these clinical and procedural variables to better characterize contributors to postpartum pain outcomes.

Finally, this study was conducted at a single large, tertiary-referral academic medical institution in the United States, and eligibility criteria included English proficiency. As a result, findings may not generalize to patients receiving care in other settings or to those with limited English proficiency. Although opioid prescribing protocols were standardized within our institution, variability in clinical practices across institutions may influence postpartum pain and opioid use. Inclusion of multiple hospital systems in future studies could improve external validity.

Conclusion

We found that African American and Hispanic/Latina patients experienced greater postpartum pain and received more opioids following cesarean delivery compared with Asian and White patients. These differences in postpartum pain and opioid consumption persisted even after accounting for group differences in preoperative pain and other relevant pre- and perioperative factors. Our findings underscore the need for future prospective research to investigate risk and resilience factors contributing to racial and ethnic differences in postpartum pain. This work is critical to inform the development and implementation of culturally adapted and personalized peripartum interventions aimed at improving maternal health, particularly among African American and Hispanic/Latina patients who may be at higher risk for poor outcomes.

Authors’ Contributions

J.M.W.: Conceptualization, formal analysis, visualization, writing—original draft, and writing—review and editing. E.R.: Visualization, data management, and writing—review and editing. A.R.F.: Visualization and writing—review and editing. J.H.: Data curation, investigation, and writing—review and editing. C.R.S., A.M., M.K.F., L.C.T., A.M.B., and S.M.M.: Validation and writing—review and editing. V.R.F.: Writing—review and editing. J.P.R.: Methodology, supervision, and writing—review and editing. M.S.: Conceptualization, funding acquisition, investigation, methodology, project administration, supervision, and writing—review and editing. K.L.S.: Conceptualization, methodology, resources, supervision, and writing—review and editing.

Data Availability

Data are available from the corresponding author upon reasonable request.