Half of black women in UK who raise concerns during labour did not receive suitable help

There will also be cultural barriers. There is also FGM - which causes enormous problems in childbirth.
Not giving pain relief is out of order. Though I notice the drive for 'natural childbirth' also affects white women e.g. scandals in Salisbury where the culture was to have a vaginal birth at all costs because natural was best and also it kept down the number of caesarians.
Natural childbirth is all very well but having a living and healthy mother and child at the end is also a good idea.

I'm white and I was treated both times as though I should scuttle away in to a corner and keep quiet like a sheep. Only one person was supportive and that was a consultant anaesthetist who did my first epidural. Coupled with the extra attitudes black women seem to have levelled at them I'm.sadly not surprised.

I hope any pregnant black women reading this news report (and thread) have some real life support as its quite a hard hitting thing to read. All pregnant mothers feel very vulnerable i think. I dont know what can be done short term but I do hope the conversation keeps happening until iis not needed any more.

Yes this is so horrifying, as Black women the health inequalities are horrible. It's the system, many medical students (research shows) and doctors believe Black women feel less pain and have higher pain thresholds. Also many medical devices have never (until recently and some not yet) been tested on Black skin e.g that tool for determining need for C-section, due to (not 100% sure, read the study a while back) kidneys etc and blood - it was found that the baseline for BAME women was higher. So essentially Black women were getting c-sections when they didn't need them, or other options should have happened first (so major abdominal surgery, hard recovery). The stereotypes of 'strong Black women' still persist and we don't believe Black women when they say they're in pain. More education is needed on BAME's women health and mental health. I once did some research on how Black women with the exact same presentations to white women and sometimes with more severe ones - would get less therapy, get antipsychotics instead of antidepressants as well - because more aggressive and 'masculine' stereotypes.

This is interesting - I was going to say that if I were a WoC and saw all those stats and were about to give birth, I would feel safer and more heard with a team that were also BAME. But that’s probably psychological as pp points out language barrier.

1 in 5 NHS staff are already non-British nationals.
An unknown quantity are British but born abroad and we're trained abroad.
When I was in the NHS I was the odd one out being British trained and also a British national.

I can easily believe this.
I remember when I was working in my last year of training, a young (early 20s) single black British woman was admitted to the antenatal ward for care, complaining of feeling just not right. Staff, doctors and midwives, openly refused to believe her. They thought, for whatever reason, she was making it all up so the council would house her locally (hospital was some way away from her home address and in a naice area).
This was said openly in the handover, instantly prejudicing staff against her.
As the lowly student I was assigned to care for her, and being from where she lived, actually took time to speak to her.
Turns out she was staying at her cousins in the naice area, to help with childcare when she started feeling poorly. She didn't want to be in hospital but wanted to look after her pregnancy, which is totally fair.
I took her obs which were fine and noticed swelling in one of her legs. I suspected DVT and raised it with the junior Dr's and senior midwives. They were so dismissive and for the rest of the shift kept sarcastically asking about my 'dvt lady'.
I had a few weeks on study block and when I came back ended up caring for her during labour. Turns out the DVT was confirmed. And her baby was small for dates due to placental failure.
I was fuming on her behalf. Unfortunately the staff attitudes towards her never changed, for the weeks she was admitted, they all believed she was there to try and 'play the system'.
Guess what. All of the Dr's and Senior Midwives making these prejudicial remarks were not white British. They themselves were from India, Nigeria, Ethiopia, Iran etc.
It really showed me that racism is so entrenched and also not as simple as white people being ignorant towards black people. It's far more complex than that, but that's what happens when you create a system where you import your staff. You also import their cultural attitudes too, and sometimes that is racism.

I havent found that the NHS routinely and timely provides interpreters. We have lots of young people we work with who dont speak English and they often cant be seen as the NHS wont provide an interpreter, appointments get cancelled, rescheduled etc

I've definitely commented on this on MN before if not started a thread.

It's been going on for years with absolutely no progression. It's utterly appalling and scandalous.

But women's health doesn't matter and we don't get angry enough about it, when we really should.

when we know that black women are most likely to be subject to racism of any group it therefore should be no surprise that this translates into maternity.
The devastating consequences are shown in the statistics and desperately need to be tackled urgently

This. When excuses for the different outcomes for Black Women have been exhausted, then what?

The figures for the increase in black women's maternal deaths should be shocking but it's in line with previous research so sadly I'm not surprised.

Lack of pain relief for a 1/4 of Black women should also be shocking, though I would point out that it's better than average according to the CQC who found that in general 1/3rd of women are denied pain relief in maternity services. There may be some differences in how the surveys were run, and possibly the much lower number of Black women surveyed makes the numbers a bit less reliable.

Maternity services are in freefall and underfunding is a significant part of that, though I think cover up culture and endemic bullying also plays a role (both of which are probably partly down to a lack of resources). But even taking that into account, I don't think we can ignore the way the NHS fails to serve Black women as well as it serves others.

I personally think maternity is in free fall and that all the principles of patient care are ignored. How many examples do we hear of/share both on MN and IRL sbout women being ignored in childbirth. The majority on here are white women, just be virtue of demographics.
when we know that black women are most likely to be subject to racism of any group it therefore should be no surprise that this translates into maternity.
The devastating consequences are shown in the statistics and desperately need to be tackled urgently

Why do you find it easier to accept that "the field is sexist" vs "the field is racist"? Why do we not just have "sexist staff members", too?

Maybe women just don't speak English well enough or are intrinsically weak and unhealthy, hence the difference in outcomes that some perceive as systemic sexism. Could just be some bad apples.

Black women are the immigrants most likely to speak English fluently. Language isnt the issue here.

Also prejudice between non-white communities or more specifically, anti-black racism/misognoir exists. So having a "BAME" team in no way makes black women safer. In fact, there are also issues where all staff prioritise the care of the most affluent groups as part of defensive practice. This becomes more of a problem as the demand on scarce resources increases and the people with the loudest voices can ensure they are heard first.

Personally, the things that have alienated people I know from maternity services stem from cultural differences and ethnocentricity. It has led to them being reluctant to ask advice or share concerns because much of what they know and say will be rubbished as old wives tales or plain ignorance.

Listen I don't disagree with the examples you have highlighted. Heck, I am sure as hell across the NHS you'll find racist staff members! The entire field of medicine is sexist! We've known this forever!
My point was, (which I probably didn't articulate very well), is that the disparities in maternal health, that black women experience, stem from a complex interplay of many different factors including, biology, systemic biases, socioeconomic issues as well as overt and subtle racism. It's not as simple as saying its systemic racism:- address this and problem solved! It's multifaceted; its complicated. And it's very shit. 😔

That’s fab. I like to think it’s getting better as my training was years ago now as I said.

But then it was only 2 years that a black woman died in pregnancy and racism was found to have contributed to the cause.

www.bbc.co.uk/news/uk-england-merseyside-68300655.amp

My area is one of those under investigation I think. A baby in our village was stillborn, I believe they found failures in care.

It’s just a constant refrain on here, that women are receiving poor care. That is bad enough in itself, before you add in particular groups getting care that’s even less adequate.

@BarkItOff i did GCE and Alevel Biology. We talked about foods enriched with vitamins- margarine having vitamin d because of rickets, and poor light levels in this country, and its particular importance for immigrant families that wouldn’t be aware of the increased need in our grey country. I also saw a programme encouraging Asian mothers to cook with margarine instead of Ghee because of the vit d

Maybe I just had interesting science teachers- it does sound like a bit of an aside now I think about it.

Coronation Street has done a recent storyline raising awareness about this after DeeDee, a woman of Caribbean heritage, almost died from pre eclampsia after being repeatedly patronised and dismissed by midwives. I know it's fiction but it's awful that this reflects the reality for so many women who are just not listened to.

You are misunderstanding me.

I am not saying the staff are racist. I am saying the SYSTEM is racist. Look at how the training is delivered using examples on white patients, white patients in medical text books, have you ever seen a black CPR dummy? And again the example of phoning triage that my trust just audited.

It is but it’s overlooked.

Some examples from my student years. We are taught about the importance of vitamin D supplementation in pregnancy. No one ever mentioned that darker skins have higher vitamin D requirements and so need a higher dose. Learnt that myself later.

I often heard the ‘strong black woman’ rubbish touted to justify black women needing less pain relief.

This is going back a fair few years but even now I’ve witnessed people rolling their eyes when a patient has an interpreter. I understand it because often you have the same amount of time allocated to that woman and it obviously takes longer but that means the woman ends up not getting all the information because the midwife is rushing.

We did an audit recently of all the non english speakers booked for care at our hospital. Do you know how many of them phoned the triage number during their entire pregnancy? ONE! Do we think they never had reduced movements, never had any concerns or is it that they can’t access that service? We’ve now launched a walk in service for women who don’t speak English so they are told they can just turn up. But how many other trusts still have the phone up before coming advice?

@RethinkingLife the service does get audited. The BAME midwifery team was set up in response to the fact that we know BAME women suffer poorer outcomes and generally feel less satisfied with their maternity experience.

There's so much I could say here but do feel it would be too outing.
I will say at our trust the vast majority of the obstetric and medical team are BAME. Of the senior obstetric team the majority are not British born and trained and practised outside of the UK before coming here. I make this point because I don't think it's as simple as saying the NHS is systemically racist as one poster above suggests. These doctors of ours are highly experienced and trained and worked in countries where the population is predominantly black/brown...so they are fully aware of how symptoms present in darker skin vs white skin for example.
Our midwifery team on the other hand is roughly 70% white British. However I've noticed the proportion of black women coming through as midwifery students is increasing; with one recent cohort 7/8 were black British.

Has the service been audited as to why?

If it’s not outing, is it likely to be one of the 10 in the investigation?

From the above survey.
There is a need to listen better to women from ethnic minorities so as to avoid health professional misconceptions and presumptions about women’s expectations and experiences of their perinatal care.
Dr James Bamber

More here if anyone is interested.
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15987