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Guest post: "Black women are four times more likely than white women to suffer a maternal death. Practical steps for safeguarding your rights in maternity care."

(51 Posts)
JuliaMumsnet (MNHQ) Tue 30-Mar-21 15:36:09

Evidence repeatedly shows that Black, Asian and mixed ethnicity women are more likely to die, experience baby loss, become seriously unwell and have worse experiences of care during pregnancy and childbirth, compared to white women, in the UK. Birthrights charity is convening a national inquiry into racial injustice in maternity care. Solicitor Olivia Boschat, who is working to support Birthrights in their national inquiry, recommends some key steps women can take to safeguard their rights during their experience of pregnancy and childbirth:

"Your rights

Every person has the right to receive appropriate healthcare, whether privately or through the NHS. The right to safe maternity care is fundamental to the wellbeing of women, their children and their families.

Women have the right to equality, which means that they should be free from discrimination. Appallingly, this isn’t always the case. There is repeated evidence of racial inequality and injustice in maternity care in the NHS going back many years. There’s also a clear link between the number of women dying during and following pregnancy, and their racial background.

I hope to provide some practical advice so that women can know what their rights are, what steps to take to minimise risk of harm and what to do if things go wrong.

Making decisions

All patients have the right to be involved in decisions about their treatment and care. In order to be able to do this, patients have the right to know the risks of each procedure and the alternatives to it.

Medical professionals must support women to make informed decisions. Women have the right to be listened to, and to be given the information they need to make a decision. They must be given the time and support they need to understand the treatment, alternatives and consequences.

Medical professionals must, by law, gain informed consent before carrying out any form of medical treatment, unless the patient lacks the legal capacity to decide.

This means that if you don’t understand something, you should ask for it to be repeated. The doctors and nurses caring for you have to explain the treatment to you in a way that you understand and give you the time you need to consider the options. You’re not being a nuisance. You have a right to ask.

Practical steps to take

For many people, any form of hospital or doctor’s appointment can be nerve-wracking. When pregnant, women are more vulnerable and it can be overwhelming. Coronavirus has amplified the anxiety and stress involved with many women not being allowed to bring a partner or person to support them during antenatal or postnatal appointments.

I recommend anyone attending an appointment to jot down questions beforehand. There’s nothing more annoying than remembering a question when you walk out of the appointment room, and having unanswered questions can increase anxiety. Having a note of questions in advance can help jog your memory and make appointments less stressful.

A great tip is for you to take note during the appointment of key points the doctor or nurse has explained. If you don’t understand something, ask for it to be repeated. This is your medical care and you have a right to understand it.

Try to carry out some research online via organisations and charities to gain knowledge about pregnancy, what can happen and your options. The charity Birthrights has abundant advice and resources to equip women and families during and after pregnancy.

The organisation Five X More has identified Six Steps that pregnant women can take to help minimise harm.

What if something has gone wrong?

If you’re worried that something has gone wrong in your medical care, I strongly recommend you ask questions so that you can understand what has happened.

The first step I recommend is to request a copy of your medical records from the hospital you’re being treated at. Medical records should be kept for all patients having medical treatment. In a maternity setting, they will be completed by midwives and doctors. You’re entitled to see your medical records.

Each hospital in the NHS will have a medical records department and procedure for you to request your records. You may be asked for a signed form to access your records, but you shouldn’t have to pay for them. Getting your medical records may help you to piece together the medical treatment you received.

If you’re worried something has gone wrong, you may wish to make a written complaint letter to the hospital to ask questions. There’s no shame in doing this. Each hospital has a Patient and Liaison Service (PALS), and they can give you access to the hospital’s complaint procedure and help you to understand what has happened.

I would urge anyone who thinks something has gone wrong in their medical care to reach out and speak to charities for support and guidance. In particular, the charity Birthrights supports and campaigns for women and families during and after pregnancy. They have recently set up a national inquiry into racial injustice in maternity care.

This inquiry will investigate how racism in the NHS is adversely impacting mothers and babies, and maternity care as a whole. The aim is to determine exactly what needs to be done at all levels to effect change.

Legal claim for medical negligence

As a solicitor specialising in women’s health, I sadly see the impact of medical mistakes on individual women and families. I assist women who have suffered physical or emotional injuries as a result of substandard medical treatment. I also specialise in helping families when their child has been seriously injured during labour and birth. I help families to get justice when the negligence has caused death.

The aim of a medical negligence claim is to obtain compensation (money) from the opponent. In order to win a medical negligence claim, you have to prove that:

1) The medical treatment provided was so poor that no other responsible body of medical practitioners would have provided it (this is called breach of duty); and

2) This breach of duty caused a significant injury which should have been avoided had the treatment been legally acceptable (this is called causation).

A legal claim for medical negligence is not a route anyone really wants to pursue. Every client I’ve represented would much rather the negligence had not occurred. For many injured people, the damage has cost them not only physically and emotionally but also financially.

While money can very rarely compensate a person for the extent of the injury suffered, it can help with recovery, medical treatment and support for the future.

Olivia Boschat is an Associate Solicitor in the Women’s Health team at Bolt Burdon Kemp and can be found on twitter here @omitchisonbbk

OP’s posts: |
dinochum Wed 31-Mar-21 09:44:02

My experience of NHS maternity care is that they invoke coercion rather than seeking informed consent. Should you question or God forbid disagree with a HCP They escalate it to either a midwife above them, a doctor, a consultant… "dead baby" is then waived in front of you, mentions of social services under fake concern for baby's welfare.

"Listen to us or you don't care about your baby"

No wonder so many women are railroaded.

KeflavikAirport Wed 31-Mar-21 11:51:43

Presumably this is only within the UK context. Worldwide the vast vast majority of the women who die in childbirth will be black or ethnic minority.

BigGreen Wed 31-Mar-21 11:53:55

@MNHQ can you campaign about this issue? It's so vitally important.

Traveller3367 Wed 31-Mar-21 12:48:49

@dinochum
Well dead baby is often a risk of decisions mothers make. They are only making it clear that it's a risk. Would you rather they didn't tell you?

Redruby2020 Wed 31-Mar-21 13:12:26

dinochum

My experience of NHS maternity care is that they invoke coercion rather than seeking informed consent. Should you question or God forbid disagree with a HCP They escalate it to either a midwife above them, a doctor, a consultant… "dead baby" is then waived in front of you, mentions of social services under fake concern for baby's welfare.

"Listen to us or you don't care about your baby"

No wonder so many women are railroaded.


I agree, I have been put off of asking for help, because we are told one thing and experience another.

GrumpyHoonMain Wed 31-Mar-21 13:21:35

One thing that isn’t mentioned by any study (but which caused maternal deaths at Milton Keynes) is that it was female BAME midwives and consultants who under-recognised the pain of their compatriots. I was told by many female Indian and black consultants and mw that I was too anxious, making too much of a fuss, they tried to use ‘familiarity’ and our shared culture to shut me up. But funnily enough after my baby’s life was saved after the interventions I demanded none of these women even wanted to see me to check how my baby was.

So my advice would be

GrumpyHoonMain Wed 31-Mar-21 13:22:57

So my advice would be to research, document, make notes, take down names and job titles, and basically have enough info that you can use PALS as a credible threat.

Hoowhoowho Wed 31-Mar-21 14:39:39

One of the trustees of Birthrights was heavily involved in my maternity care with my first child. Let’s just say that her discriminatory attitude to women with disabilities is evidenced in email correspondence .

I am not sure this a charity I could trust to conduct an inquiry into discrimination of any sort.

Howzaboutye Wed 31-Mar-21 15:08:32

I observed racism on the maternity wards between black and Asian patients and non-doctor staff. The level of pre-judging by staff of their patients was horrendous. The staff attitudes were poor and they all needed a right rollicking in how to treat their patients with respect.

My advice to any mother giving birth is have a pushy birth partner with you, and kick up a massive fuss if you feel it isn't going well.

Veex21 Wed 31-Mar-21 15:31:01

My twins died after premature rupture of my membranes. From the moment I was wheeled into the hospital I was treated poorly. I even heard a nurse outside my door bad mouthing me to a doctor (that I was giving it the biggun by not having pain meds but now look at me), I was left with a student midwife, criticised about my ivf choices, told that I already had a son so losing my babies shouldn't be too bad. It even went down to my babies being taken away without me seeing them until the next morning. I could keep continuing.

I complained to pals and what I got was a 'lesson will be learned ' as well as nurses and drs saying they didn't say or do that. If they had made me a priority when I got to the hospital 1 or both of my babies could have been saved. I didn't lose my life but I very nearly did.

EKGEMS Wed 31-Mar-21 16:12:11

Considering I was on life support four days after my emergency c-section (precipitated by pregnancy induced hypertension and a gall stone leading to pancreatitis and ARDS) with some fabulous, top notch pre natal care as a white woman I worry about all pregnant mothers. We need top medical care worldwide despite race or religion

HmmmmmmInteresting Wed 31-Mar-21 16:25:43

@Veex21 I'm so sorry. flowers

Veex21 Wed 31-Mar-21 16:50:13

HmmmmmmInteresting

*@Veex21* I'm so sorry. flowers


Thank you x

GrumpyHoonMain Wed 31-Mar-21 17:44:54

Veex21

My twins died after premature rupture of my membranes. From the moment I was wheeled into the hospital I was treated poorly. I even heard a nurse outside my door bad mouthing me to a doctor (that I was giving it the biggun by not having pain meds but now look at me), I was left with a student midwife, criticised about my ivf choices, told that I already had a son so losing my babies shouldn't be too bad. It even went down to my babies being taken away without me seeing them until the next morning. I could keep continuing.

I complained to pals and what I got was a 'lesson will be learned ' as well as nurses and drs saying they didn't say or do that. If they had made me a priority when I got to the hospital 1 or both of my babies could have been saved. I didn't lose my life but I very nearly did.

Sorry to hear that. I had an ivf baby too and I wonder if many nhs staff just don’t recognise the medical conditions that require it. A lot of staff just assumed I waited too long for a baby until I complained they shouldn’t be discussing my situation at all.

Livpool Wed 31-Mar-21 17:52:01

@Veex21 I am so sorry for your loss. And the way you were treated.
This makes me so angry

Veex21 Wed 31-Mar-21 18:16:48

It is definitely none of their business and they shouldn't be vocalising any opinion about a patient's choices to them or in ear shot!

dinochum Wed 31-Mar-21 18:17:19

Traveller3367

*@dinochum*
Well dead baby is often a risk of decisions mothers make. They are only making it clear that it's a risk. Would you rather they didn't tell you?


There are ways of discussing and imparting statistics and facts without deliberately attempting to manipulate and coerce the outcome.

Some people enter pregnancy and the whole experience uninformed and perfectly willing to submit to the opinions of the medical personnel and that is their choice to make.

Likewise, some people are more informed yet still, no respect or willingness to deviate from the "one size fits all" "conveyor belt" approach.

I think the biggest issue is that women are not animals. Individuals will express differences of opinion and there is an overwhelming lack of willingness or acceptance of responsibility to respect that.

Of course, I can only speak from my personal experiences.

Veex21 Wed 31-Mar-21 18:18:34

Livpool

*@Veex21* I am so sorry for your loss. And the way you were treated.
This makes me so angry


Thank you. I don't speak about it much because when I do I get so angry and feel let down at my worst time yet there is absolutely nothing to do about the rage.

More people have got to start conversating about this topic. I'm glad I'm seeing it here in this particular part of mn.

RedMarauder Wed 31-Mar-21 18:44:09

@GrumpyHoonMain they tried that trick on me.

Luckily because I was under an obstetrician's care and my obstetrician clearly had seen something she didn't like in the hospitals she worked at she wrote stuff in my notes to warn them to be careful. (She was Indian)

The (white) junior doctor in charge was pissed when she realised when I was being discharged it wasn't a physical or medical issue.

GrumpyHoonMain Wed 31-Mar-21 18:53:17

RedMarauder

*@GrumpyHoonMain* they tried that trick on me.

Luckily because I was under an obstetrician's care and my obstetrician clearly had seen something she didn't like in the hospitals she worked at she wrote stuff in my notes to warn them to be careful. (She was Indian)

The (white) junior doctor in charge was pissed when she realised when I was being discharged it wasn't a physical or medical issue.

Yes. I think going for a Labour Ward or Consultant led pregnancy early on does protect you to an extent, just because they have to sign off on your care. But I experienced my issues with a Consultant and if it wasn’t for my ivf consultant being firm in his treatment protocol and making her follow it (or sign off care to him). I have learned lessons and if there is a next time, will now hire a private midwife and demand specialist referrals a lot sooner.

Jipterjames Wed 31-Mar-21 19:14:48

@KeflavikAirport vast majority of the population are black and Asian

KeflavikAirport Wed 31-Mar-21 19:48:08

Yes, I just found the thread title a bit short on info.

Eastie77 Wed 31-Mar-21 22:22:18

@EKGEMS well that's the point, all women should receive top notch care but non-White women tend not to, hence the disparity in outcomes. You are a White women and thankfully experienced great levels of care when you needed it but it could have been a different story if you were Black or Asian.

There is really no need to turn this into a "All Women's Lives.." debate

Micah Thu 01-Apr-21 07:34:34

One thing that isn’t mentioned by any study (but which caused maternal deaths at Milton Keynes) is that it was female BAME midwives and consultants who under-recognised the pain of their compatriots

That was my question- i wonder if the stats are broken down by area and correlated with staff ethnicity. Do black women get better treatment in hospitals staffed by a high percentage of Black or ME staff, for example?

I gave birth in a South London hospital where the midwifery staff was almost exclusively black. Reflecting the diversity of the local area. Some were excellent, some good, some were awful, some had bad attitudes, but that’s my experience of the NHS in general.

I suspect this thread isn’t to support black women or drive discussion though, but to direct us to the ambulance chasing legal team....and they’ll happily take your money whatever colour you are...

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