To think condemning midwifery services as racist does a disservice to midwives?

You just have no way of knowing what happens on phone consultations, in one on one meetings, and in the 101 minor interactions that take place during a pregnancy between staff and patient. There are hundreds of moments when ill treatment, rudeness, indifference, contempt, and bigotry can poison the relationship or discourage the patient from asking or receiving help that is naturally and freely offered to another patient. It may appear as too small to you to matter. It may not appear during heroic measures or the moment of the birth. But it may occur imperceptibly but significantly all along the line of interactions.

But everyone is assuming this, sadly.

Referring to ‘so- called racism’ dismisses the wider evidence
Your experience of rude behaviour by a midwife matters, but individual bad behaviour isn’t the same as disproving structural disparities

I don't think the midwives should be taking the blame for what are more likely systematic failings in research, equipment and training. It's like blaming the shop assistants when the self services tills don't work just because they are the frontline and there.

All the medical equipment is designed around the normal readings and ease of taking readings from a white man, that is who it was tested and developed on, so some of the monitors, like the pulse oximeter, works less well on darker skin and some things don't even fit women very well. There will then be the intersection of having both for women of colour.

Similarly, a lot of research and decisions on thresholds will not have been carried out on a diverse group of people.

And finally the training will not have been on people who speak a different language to the trainees, for example, as that wouldn't be fair on them. They might be trained by people who practiced midwifery when the population was less diverse and they will be teaching general points that summarise their more common experiences "usually this happens..." this takes the underrepresentation in a data set and amplifies it, but is also not easy to fix. There should be a lot more training about how to deal with specific situations.

Of course most of us all only have stories that are snapshots of a system because we go in for a birth and just hear stuff around us.

But I recall a woman crying and being sick because there was no room ready and the midwife refusing to assess her dilation. I mean it was pretty distressing.

My view was there is no way in hell that is happening to me, and set up what I needed to avoid it. It stuck with me though, poor woman.

The woman and the midwife were both BAME (ik people don’t like that term but for this thread I’m not sure how else to say it).

I don't know if this is commonplace, but our local hospital is very multicultural. It's unusual to see a white surgeon or consultant, and all the HCA are from various parts of Asia, but the nurses and espcially midwives are overwhelmingly white British. Is that usual?

There are a lot of personalities in health care generally who just shouldn't be there. Some of their behaviours are probably driven by the environment ie understaffing. Some are plain, downright unsuited to care for sick people who need help.

1. ”Black / Asian” are two very distinct categories technically more than two when you think about the number of different ethnicities that fall under both so them expressing racism towards other black / asian people isn’t always towards people of their same ethnicity.
2. Yes they can be - if they still work within in a systemically racist structure or have been exposed to some of the attitudes that are prevalent within society. There is a black podcaster who has spoken about her experience in labour and the assumptions made about her pain thresholds (a common stereotype) about black men / women is they have higher pain thresholds.) She has said openly that she was also experiencing this dismissiveness of her pain from some black nurses

You understand that women can be misogynistic right? So why would this surprise you.

It might not be overt racism but I've definitely seen what can at best be called unconscious bias in a very multi cultural central London hospital. When my daughter was in NICU, the nurse told me off for giving a nap to the (black) mother beside me who had run out because "she'll never learn" and criticising her if she was in later because of caring responsibilities at home in a way that I was never criticised if slightly late. In the MAU I also saw black mothers being dismissed and treated poorer than I was. Obviously no one ever used a racial slur or referred to anyone's ethnicity but I can definitely see how it would contribute to worse outcomes.

@ShortnStout what on earth are you saying? I'm in the "midwives boo" camp because about half of them were insensitive and rude. They didn't or couldn't answer questions and felt the need to raise their voices if one wanted more explanation.

I have no doubt that the black midwife I asked to leave my house thought I was being racist. I asked her to leave because she was rude, laughed at me and raised her voice. Formal complaint upheld.

I wonder how much so-called racism is actually bad manners and bad attitudes.

I don't think it's as simple as poor outcomes are a result of deliberate racism, but people's unconscious bias will be at play. For example, in education, we know that black children often appear older than they are, so staff can have different expectations of them. Some cultures come across as more aggressive/less polite so receive a different response from professionals etc.

None of those people would consider themselves racist, but they do respond differently to people from different races.

And are racist themselves....

Midwives are reviled throughout world history by patriarchal societies. It’s always our fault.

Midwives have been burned as witches, banned in some countries, and blamed for pretty much everything.

The fact that women are the gatekeepers of men being able to procreate is the basis of female oppression and hatred by the patriarchy. Midwives, as further gatekeepers to birth, are not historically popular with powerful men either.

This is the reason that ‘midwives, booo!’ is the general tone rather than blaming maternity services as a whole. It has been this way forever.

There may be many black and Asian practitioners but they work within a system that has issues with structural racism embedded - and likely experience racism in their own workplace.

I think ignoring racism in midwifery services does a disservice to the women and children harmed by it.

I’d love to see someone other than midwives mentioned in these reports - the maternity team is made up of midwives, obstetricians, anesthetists, MSWs & auxiliaries, management, theatre staff, neonatal drs & nurses. The midwife is the coal face, there’s a lot that goes on behind the scenes that determine a care pathway but patients don’t see that so midwives get blamed for everything. And I in no way think they are blameless, it would just be nice to see responsibility be shared a little wider.

I'm rather surprised tbh, there are many many black/asian nurses, doctors and consultsnts working in the NHS, are they racist towards people of their own race?

When I was having DS, there was a lady in the next delivery room who sounded like she was in great distress. I asked the midwife if she wanted to go and attend to her (I was quite settled) and she said “No, it’s okay. She’s fine. She’s African. It’s part of their culture to make a big fuss.”

This, broadly and culturally speaking, is absolutely true. You can ask any midwife, African women very often are very vocal about their pain. I wouldn’t call it making a fuss! And I would never comment as your midwife did.
But it is a very common coping mechanism for African woman. Very loud, can be distressing to hear, but very common. It also does make differentiating between levels of concern difficult, but that is our problem as caregivers to interpret, not theirs.

Jehovah’s Witnesses for example though, if I had a lady screaming and wailing I would not think that was standard.

All midwives see differences between women and families from different cultures, but we’re not allowed to name it or differentiate treatment. I think that is a big part of the problem. If you dare to suggest that people from different cultures are <shock> actually different, you get branded a racist. Which helps no one, least of all the women.

Nigerian women for example, especially those belonging to a church, often have a ln older lady in the community who looks after postnatal women. A story about this:

Cobfidentially is massive in maternity, as is limiting visitors.
But a few months ago I was talking to a Nigerian patient behind a curtain who had recently come to the country. A woman from the church as above (we’ll call her P) was on the ward helping another lady. As she was leaving she heard us talking and boomed out ‘WHAT!? Who is this Nigerian voice I hear!’ as she didn’t know my patient. I went out and asked her to wait and said I’d speak to the patient.

P came in and descended on my patient like a mother hen. She told her off for not telling the church she was here, then mothered her for the next 3 hours. I let her stay beyond visiting and my patient was in tears of gratitude. It facilitated a huge support network for her as a new mum to the country.

I would NEVER dream of doing this in any other situation, and I’d have been massively told off if it was known. But this is what being culturally aware is. Different cultures ARE different and do need different care and support. It’s not racist to say so.

I would add, the pp didn't actually make any claims in her post about having been subjected to "race based prejudices". You've made that up.

Studies have shown unconscious bias against women of colour, for example studies have shown that health care workers generally believe black women have a higher pain tolerance and data shows they are given less pain relief than their white counterparts. This is quite well known and it surprises me that as someone with the experience you say you have in health care that you are unaware of it.

You say you see racism as an individual problem, this is just false. Modern racism often shows up as structural issues and unconscious bias. As in, the staff you work with I'm sure are lovely to women of any race, but you see it in studies of large data like I mentioned above. I would suggest doing some research into this as although well intentioned, you do sound quite ignorant on the subject and the women of colour receiving a poorer service deserve for this to be addressed properly.

How is the quote that you have posted in any way demeaning of her personal experiences?

I'm absolutely not denying that she had a bad experience with some BAME midwives, and I'm very to hear that. I can empathise because I too had a very bad experience with midwives.

I'm taking issue with the fact that, although she did acknowledge that her experience was only anecdote, she seemed to be extrapolating from that experience to make wider assumptions about BAME midwives - or indeed, BAME people in any caring capacity. And I don't think that's right, any more than it would be right for me to make assumptions about white midwives in general - or white people in any caring role - on the basis of my own limited experience.

To be fair, I found a lot of midwives don't have a clue. Many haven't given birth themselves and although they might understand the theory of childbirth don't have experience. My stepmother was told not to be so noisy when she was in labour. She was told she couldn't possibly be in pain. I was told I wasn't in labour as I only had a backache and wasn't making a fuss :that happened twice. I seemed to not have actual pain when in labour so wasn't in labour according to them. I was told to go home as I was nowhere near giving birth. An hour later baby was born. I was made to feel like I was a nuisance. I didn't get to the delivery suite with that one and gave birth in a bed on the ward. They had made their mind up and that was that. Other women have told me similar stories, midwives being dismissive because labour wasn't textbook and they didn't have the knowledge to think.
Since then I have come to the conclusion, for other reasons, that many medical professionals aren't as clever as they think. Once they make their minds up they won't be shifted.

You said
I find it's generally best not to make assumptions about entire ethnicities based on very limited experiences of just a few people.
This was after she gave her experience with race based prejudices birthing her child.
You were absolutely demeaning her with your passive aggressiveness.

Absolutely this.

Having worked in the NHS for years, many of them in women’s health, my opinion is that virtually all the problems with patient care come down to three things, budget cuts, short staffed and whistleblowers being ignored when they report bad practices. All of those things are easily fixed. No amount of “online training courses “ will fix anything whilst we fail to address the three things I listed. Just my humble view.