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

[mids2019]

https://www.bbc.co.uk/news/articles/c30968817q3o

Certainly staffing issues in maternity wards needs to be addressed as well as other resources but from experience in working in healthcare I genuinely don't recognise racism as being prevalent amongst healthcare staff and so really don't see how this report is coming up with such conclusions.

Instead of blanketing a hard pressed work force with being racist shouldn't we be focussing on why race may be correlated with poorer outcomes looking at factors like language barriers, cultural expectation of birth, uptake of ante natal care amongst suffering communities and general health disparities?

Maternity care like a lot of areas of medicine is open to improvement but to demonize hard working staff I don't think is the way to go.

I completely agree with you.

it is just part of the problem - the BBC report is being lazy in their headline

NHS maternity units often cover up harmful errors in childbirth, report finds | NHS | The Guardian

I work in health care and genuinely every member of staff genuinely tries to do the best for their patients even though there are obvious pressures. You need to support services with training and staffing not antagonize them by saying they are racists and bigots.

I really find it insulting to think a midwife team would suddenly decide to reduce their level of care due to the mother's race or social background. Does.a midwife decide to change an epidural strength of baby monitoring frequency because they note the colour of a mother's skin? That is simply absurd and insulting to staff who all go through absolutely thorough EDI training .

i have read before that black women are often ignored when in pain and in labour and the report mentions asian women being called princesses

I will get hammered for this I am sure, but I don't think a 3 year direct entry training is adequate for midwifery. Not given the additional high risk pregnancies and all the extra technology today.
Obesity, comorbidity and maternal age are huge risk factors needing more monitoring, extra care and extra need for intervention. All are much more prevalent now than 30 years ago.
I did my training decades ago when it was a one year course. However, you had to be State Registered (3 years) with at least a year's post reg experience. The course was increased to 18 months just after I qualified because it was agreed that it was necessary.
I read yesterday that newly qualified midwives can't even get jobs.
The whole service needs an overhaul.

Do you not think that the research that has found worse outcomes is correct?

Do you think women who report discrimination are incorrect or lying?

People can be racist. It would be weird if there were racist people in every walk of life except midwifery.

Pooorer outcomes for Black women (and some other ethnic groups) persist even when accounting for lots of these differences. And there is plenty of evidence showing that women’s pain and concerns are more likely to be dismissed when they’re from an ethnic minority. It’s often unconscious bias rather than purposeful worse treatment but you need to acknowledge the problem as a first step before solving it. I realise it’s hard for midwives to hear but also very hard for all of the women and families who have received poor care and had terrible outcomes which were preventable. It’s clear that there are v big problems in maternity care in this country and defensiveness and not being willing to admit mistakes have been made is part of that. Look at how much the NHS spends on negligence cases etc for maternity.

It is important to be honest about what this actually means
A formal report into midwifery would not be commissioned , researched and published without evidence
These reviews involve data analysis, testimonies , case studies and professional oversight . They are not based on feelings or isolated incidents
When a report concludes that there are racial disparities or systematic issues,this points to patterns , not one off events
Systematic racism doesn’t require every individual midwife to be racist . It refers to structures , practices and outcomes that consistently disadvantage certain groups . This is commonly known in the legal sector ( I have worked as an Employment Lawyer) as indirect discrimination
Dismissing a report without engaging with its evidence prevents improvement.

Should such issues not be reported?

Structural racism and persistent inequalities leading to "notably higher risk of adverse outcomes" for women from black and Asian backgrounds and women from more deprived areas. Discrimination against disabled women, Muslim families, refugee and asylum women and LGBT families was also reported

I'm sure this is not a criticism of EVERY SINGLE midwife, but the truth shouldn't be ignored. To do that would be dismissing the lived experiences of women of colour in these situations, myself included.

I come from a position of working in a different area of healthcare where for many years I have seen exactly the same level of care given to patients independent of race. It is simply deeply unprofessional to give substandard care due to ethnicity and any heath care staff member that did this should be disicpined.

This is different to labelling a while profession racist and culturally determined to somehow deliver varying levels of care simply because a mother's background. No doubt in a huge organisation there may be isolated events of racism but to label a while profession as bigoted is surely counterproductive and will just reduce trust between midwives and mothers unecessarily. Remember midwives and obstetricians are a diverse work force within themselves.

Health disparities between different demographic groups should be explored but I am sure if you dig down into the statistics there would be many co factors in maternal and neonatal health apart from race e.g. deprivation.

I think we have to recognise mothers will not necessarily be surrounded by midwives from the same or face or community when they enter hospital and I wonder if work has to be done with mothers themselves to make them feel comfortable with for instance a predominantly white birth team to improve general trust and confort?

As a midwife I think it would do a disservice to black and Asian women to not recognise that they are far more likely to die or have bad outcomes in pregnancy and labour than white women and look into the reasons why.

i don’t think it’s individuals deciding to be racist and not provide care but I do agree there’s a danger of a systemic racism, Not taking pain seriously, i remember a case when I was a student midwife of caring for a black woman who was also,Spanish who was really distressed in Labour and the midwives at the station rolling their eyes and tutting but a lot of conversation about how it wasn’t unusual for women of her background to be like this. At the time I thought they meant Spanish but now I’m not so sure.

I work in a very non multicultural area, so in 20 years she was the only black woman I cared for. Maybe in a more multicultural area there wouldn’t be the same myths?

but language barriers is a massive problem and is it systemic racism which means people aren’t quick enough to use translation services?

the fact as a student and indeed as a midwife we were never trained how to recognise jaundice in babies that weren’t white? Or be trained that a DVT might not be as easy to recognise?

Health disparities between different demographic groups should be explored but I am sure if you dig down into the statistics there would be many co factors in maternal and neonatal health apart from race e.g. deprivation

I believe they did that and found even when removing other variables such as deprivation there are still worse outcomes.

There’s a whole load of personal accounts within this report. We shouldn’t not believe the women just because it’s hard to hear

https://birthrights.org.uk/wp-content/uploads/2022/05/Birthrights-inquiry-systemic-racism_exec-summary_May-22-web.pdf

It sounds more like you don’t like the idea of accepting what is increasingly becoming obvious is a big issue and I don’t think it’s just in maternity but in healthcare across the board.

The evidence is pretty clear and instead of people putting heads into the sands steps need to be taken to look at how the system can be changed to best meet the needs of everyone.

I do think disparities in health care should be looked at but surely at heart differential outcomes are going to be due ultimately to differing medical factors between races e.g. sickle cell disease amongst afro carribeans. We should definitely address factors that lead to differing health care outcomes but I think we can do this without getting a profession as racist.

I think at times a poor midwife is a port midwife and what could be construed as poor pracrice due to racial bias is simply poor practice and we should we address the practice without conflating the issue with perceived racial bias which in my opinion leads to distrust.

The language barrier one is an issue systemic to the NHS and I am aware many trusts have reduced translator costs due to expense and the difficulty of having the right language speaker there at the right time.

I know from anecdotal conversations some people from certain ethnicities and religions would be more comfortable with a healthcare team of similar backgrounds or ethnicity testing them so racial bias works both ways. I am just concerned that women of colour are going to enter the ante natal.system already guarded about a system which has maybe unfairly labelled as racist.

It also neglects the fact that a third of the midwifery workforce according to the nmc identifies as BAME, which is about twice the representation in the population. In london the majority of midwives are from bame backgrounds according to the nhs. So Bame women may also have poor experience at the hands of Bame midwives - as may white women - which doesn’t mean there isn’t structural racism in the nhs but does mean it is complex.
I have to say my own experience as a white woman in labour was of my pain being completely dismissed by bame midwives in London. “If you think this is pain you just wait”…”you aren’t pushing you are just shouting and wasting all our time”. I never thought of this as “racism” but it fits the princess model - I was certainly treated like I thought I was special. All I wanted was some compassion and help during a 48 hour labour which left me ripped apart and my son subsequently with some Sen that I cannot help but attach to the brutality and length of his birth.
I need to read the report but agree with a pp that blanket accusations of racism are unlikely to be very helpful in understanding the problem. However understanding some of the cultural and educational as well as institutional perspectives some midwives may also bring to their practice and the degree to which this is suited to the care of a maternity population with increasingly complex conditions may well be useful.

Maybe it's just me but working in healthcare I see a protocol driven servo e where healthcare needs are given without reference to patient background unless there is a medical necessity. We have a diverse clinical staff and I have me we seen a case where someone's health care has been demonstrably reduced because of their ethbicity. That is professionally unacceptb le. I see racism as an individual problem and not systemic as I would think the last majority of health care staff are professional.

A lot of midwives are black and Asian of course. I wouldn't imagine necessarily the racism is necessarily white on Black.

It’s not due to different medical factors. I promise you they’ve looked at this. When the first national report came out saying about the outcomes that was very much the opinion.

I remember people saying well black women are more likely to bleed afterwards so no wonder more die of post partum haemorrhage . But it’s now been found that yes they have more pph but because of substandard care, not because of biology.

and sadly attitudes that it’s due to biology are part of the problem. A midwife believes this and doesn’t act on a moderate pph quickly enough as she believes it’s normal for that black woman. Then it’s catastrophic. If you asked her if she was racist she’d be heartbroken and deny it. But ultimately she’s treated someone differently due to their skin colour.

This report is the reality of women’s experiences.

you are failing them by denying what’s happening. That will continue the problem

I’m a lecturer now and sadly such attitudes are still there with my students. Sweeping generalisations, talking about how “they” are “just like that”. Normally related to making a fuss/not coping. And they don’t see the issue. I know they’re picking up on the culture in placement so I know it’s a problem.

Tbh OP its glaringly obvious you are part of the culture. You are dismissing the report! Women are sick of being dismissed!

For a few years I worked very closely with parliamentarians on this issue, including two separate investigations.

There is definitely an issue regarding inequalities in maternal health and part of that was down to the way women from different backgrounds were treated. This was not necessarily overt racism but ignorance of different requirements of healthcare for women from different cultures and ethnicities.

There is a lot that needs addressing in maternity services. However, I am always keen to defend midwives. There is a difference between being reckless and making a genuine mistake. The NHS has trouble with this distinction. Midwives are afraid to admit to genuine mistakes. Lessons cannot be learned.

The entire culture in the NHS needs sorting.

I must add, there was overt racism in some cases, which, as in any walk of life, is wrong and should be prevented.