Thread by @OBsleepmerchant

@SQuashie presents on ethnic disparities in #OBAnes outcomes at #Anaesthesia2023… lots in lead up to #OAA23ASM

A break down of the objectives of the talk. Census data demonstrates increases in all minorities, nationally and locally. Definitions: What is a health disparity? >10% health difference closely linked to disparity. Inequality, equality, equity and justice are linked.… twitter.com/i/web/status/1…

Race vs ethnicity - an important difference. Maternal inequalities have been subject of several reports, resulting in Maternal Disparities Taskforce and Equity & Equality guidance. Reducing inequalities focus on CORE20PLUS5: the most deprived 20% with 5 key clinical areas… twitter.com/i/web/status/1…

#COVID19 provides a good basis to look at inequalities in healthcare, differential effectiveness of control measures. Impact on multiple levels starting well before coming to hospital/ receiving care. Inequalities in maternity healthcare: stark @mbrrace data, maternal mortality… twitter.com/i/web/status/1…

Social deprivation and ethnicity associated with stillbirth and fetal growth restriction. #OBAnes outcomes analyzed in recent national cohort study in @Anaes_Journal from @LateralTilt @SQuashie @noolslucas and @Marianfknight. Minorities more likely to have GA for elective… twitter.com/i/web/status/1…

Differences also seen in emergency cesarean sections, both less and more likely to receive GA. Neuraxial uptake for vaginal birth - data less clear. #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM)

Unassisted vaginal birth acts as a surrogate. Definitely lower uptake in most minorities (Bangladeshi very low). Interestingly Indian exception - why? Irish white have remarkable uptake (@ISOA_Ireland). #Anaesthesia23 #OBAnes (prelude to #OAA23ASM)

When one looks at assisted birth and emergency sections for different ethnic groups, things are concerning. #Anaesthesia23 #OBAnes (prelude to #OAA23ASM)

Discussion: evidence of ethnic differences in #OBAnes maternity care. Certainly limitations to the study, but some very important strengths. Looking at US data (@aljabut) - similar findings less neuraxial labour analgesia, more GA sections and maternal mortality gap persisting.… twitter.com/i/web/status/1…

Why do disparities exist? A primary concern may be language barriers both antenatally and on presentation to labour ward - @labourpainsOAA (now labourpains.org) have options.

Also of note is lack of community/ ethnicity specific educational media - a google search only… twitter.com/i/web/status/1…

Are their biases in care? Microaggressions are present - some subtle, some not. What is the impact of disparities? Extends antenatal, through #OBAnes to postnatal/ early neonatal care. Different ethnicities have a different maternity experience. A cultural problem exists?… twitter.com/i/web/status/1…

What impact does workforce diversity have? If we don’t see ourselves, does that affect how we interact with maternity services? Certainly distrust is possible. Discrimination towards “other” exists at a workforce level, ethnicity definitely a factor - this probably overflows… twitter.com/i/web/status/1…

Tackling inequalities begins with the man in the mirror (HT @michaeljackson), individual members encountering maternity care, and expands outwards towards a national level.
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM)

Take home messages from @SQuashie and acknowledgement of co-authors @LateralTilt @noolslucas @Marianfknight, support of @OAAinfo. Link to @Anaes_Journal article.
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM)

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