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 think half the problem is people in the profession not acknowledging this. It's a fact, this isn't the first piece of research that has been undertaken. My 13 year old asked me about this yesterday, I'm black she is mixed race. She was asking why outcomes were worse for ethnic minorities and we discussed unconscious bias and how people make unfounded decisions about other races. She asked me if I was worried when I went in to labour and I did say yes a bit but your Dad is white so I had him to advocate for me do I was genuinely less worried as I knew the midwife would listen to an educated white man whilst ignoring an educated black woman. I remember discussing this with a friend who is a white nurse who was offended just the same way you (OP) were a number of years ago when similar research was published. I think (hope) the penny dropped when I said but it's a fact that if both our daughters went in to hospital on the same day to have their baby, statistical my daughter had a higher chance of not have a straight forward labour and being ignored or an even worse outcome. Unfortunately it is systemic and I am once again disappointed but unsurprised that this isnt being taken seriously.

Why are you so defensive about this? The stats are there clear as day
Midwifery suffers from staffing and funding issues, sure, same as other professions in the NHS but there is clear unconscious bias that yes, could then be termed as racism
Such as black women not being given enough pain medication or not having their concerns listened to

It's a bit worrying you aren't understanding racism is not an immediate bell ringing out and a sign flashing INDIAN WOMAN INCOMING TIME TO MAKE CURRY JOKES

It's unconscious judgements usually and in labour care those judgements could lead to worse outcomes as there's so much more to go wrong than say, a wound dressing

This! There are modern beliefs which are just as rooted in racism not science as the old thinking that black women feel less pain/ need less pain relief.

This issue is complex. Black midwives are common in London hospitals as the wind rush generation nurses (at the time)were given the elderly care & Labour wards. I don’t think midwives are racist in the “send em back” way but the different cultural experiences lead to stereotypes that distort safe care. I was quite surprised at some of the comments made to me by black and white nurses when I had my children. I didn’t have pain relief so was praised for this, not making a fuss, not like most white women. So it is not an easy thin go to define or fix.

My own personal experience is of very poor care from BAME midwives. I am in London where a large proportion are BAME. I was laughed at for talking about miscarriages and treated as if I was making a fuss during labour, until a consultant came and recognised what was going on for me
and helped me. The aftercare on the labour ward by BAME midwife’s was also terrible. I always thought of it as they were from a much more “tough love” culture than ours. I had wonderful care from white midwifes. Anecdotal, but it’s made me think about how we approach care in different cultures and worry about that for when I might need future care as an elderly for example.

A key factor of sickle cell disease is mis treatment in hospitals due to lack of knowledge and the belief that sufferers are lying about levels of pain or drug seeking. Because of race.

I was treated very differently as a young poor woman of twenty giving birth to how I was as an affluent woman in her mid thirties giving birth. The first occasion I was ignored, accused of ‘making a fuss’ and the pain I was in was largely ignored and treated with distain. The second occasion I was listened to l, empathised with and treated with respect.
I absolutely believe unconscious bias exists in treatment of black and Aisian women in hospitals and it is vital that doctors/ nurses/ midwives recognise this so they can challenge it/be aware to ensure they give everyone the best treatment they can.
its scary those who work in healthcare are denying it, you are unfortunately part of the problem.

I’m a midwife. Women aren’t making it up.
A lot of the time I have seen BAME women have poorer outcomes because:

• they can’t speak English
• they presented too late
• they haven’t accessed adequate antenatal care
• they are in controlling relationships

etc. However -

I have also seen BAME ignored and called princesses. The truth is that midwives are people like any other cross section of society and many are not culturally aware. Women from different cultures DO often have distinct expectations of childbirth. Unbelievably, there is no training given in this as a student.

A few broad examples. I’m not saying everyone from these cultures is the same:

Asian women (Pakistani, Indian, Chinese) often expect to be cherished and to do
nothing for themselves, not even get out of bed after birth. This isn’t because they’re lazy, it’s because the (wonderful) culture among women for them is that the woman having a baby IS a princess to be cared for and to not lift a finger.

Some women from BAME (particularly African ime) can be very vocal when they begin to be in pain. Wailing at 1cm etc. This is sometimes viewed as ‘making a fuss’ but it isn’t, it is just a different (and not ineffective!) way of coping with the pain and fear.

Please don’t pick my post apart in an attempt to make me sound racist. One of the main issues here as I see it is that it is very frowned upon to suggest that different cultures are indeed different.

One of my major passions in practice is learning about and doing all the little cultural things that a woman who isn’t in her own country might really appreciate.

• ensuring that Muslim families can say the Adhan. It is of huge significance for some Muslims that the Adhan is said into the baby’s right ear immediately after birth, so that it is the first thing they hear. I have never had a family ask, but they are always so happy and grateful when I offer. I’ve even facilitated a silent theatre until it is done.

There are loads of examples but I need to get the kids up.

What I’ve never seen is midwives who just can’t be arsed with BAME.

@mids2019 sickle cell disease doesn’t just affect black people either. This is a common myth which can also cause disparity in healthcare and outcomes along race lines. It is found in people of Hispanic, South Asian, Southern European and Middle Eastern ancestry.

If there is institutional racism it needs to be called out and changed.

Part of the issue is, as amply demonstrated by the OP, the feeling among certain health professionals that they can do no wrong. That somehow working for the NHS makes them angels on earth, rather than a very large group of ordinary people with all the issues ordinary people have.

I’d far rather be cared for by a midwife like @ActoBelle or @ShortnStout who fully acknowledge that the system isn’t perfect.

Unfortunately op I think attitudes like yours are part of the problem. There are huge issues within the culture of midwifery. It's paternalistic, judgemental of women and reluctant to take a long hard look at itself and make the changes needed. "Normal birth" culture for starters. There is newspaper article after newspaper article, endless case studies demonstrating this, where women have been ignored and not listened to because a midwife thought they knew better, resulting in tragic outcomes. There is research evidence to back this up which you yourself have posted and a public enquiry currently underway which I'm sure will demonstrate the problems further.

It's not good enough any more to say "but we're all doing our best, be kind!". You need to recognise the whole culture of the profession needs to change.

The reality is if you’re seen to be educated, articulate, confident and can advocate for yourself, you’re more likely to receive a better response from services. If you behave in ways professionals don’t like or understand you’re more likely to be dismissed.

The report gives clear examples of experiences of black and Asian women, no it doesn’t mean everyone in the profession is consciously racist, but there are clearly cultural and systemic issues which actively work against the safety of black and Asian women. Ignoring or dismissing that is in itself a form of racism. If it was just about language differences or poor practice, white women would have the same outcomes, and the report clearly shows that not to be the case.

So, what assumptions are made about black women that might affect their health care? Why is it harder for a black woman to be heard when advocating for herself! Why is her baby more likely to die than the white baby in the next room?

Why are you ignoring posters who are pointing out that the researchers have accounted for the other factors you mention? Do you honestly think they wouldn't have thought of that?

This.

OP, issues like this persist when people in the profession dismiss the concerns, instead of being open to research findings.

The safety and dignity of women and babies needs to be prioritised over midwives feelings, I’m afraid. It’s that simple.

Its very convenient to blame the issues that women of all races experience in maternity services (and plenty of other services in the NHS) on Racism, its a handy scapegoat.
What makes Midwives uniquely racist? (if they actually are at all)

NHS has a shortage of 2500 midwives, that amount of staff shortages is going to lead to awful out comes but so long as this is all blamed on racism, nothing will change, far cheaper to blame Racism, than address staffing and overall maternity care...

Newly qualified midwives cannot get work, why? NHS hasn't enough money to employ them.
Increase workloads on existing staff, more poor care, burn out and retention problems.

Yet we all begrudge paying more tax....

This is report into midwifery, it's not a comparison to other services, it's not saying midwifery is uniquely racist.

It's also not saying racism is the only issue. If you read the article not the headline, it identifies 6 key areas for improvement, including capacity issues

So you would deny patients experience of healthcare services to protect the feelings of midwifery?

I don't disagree that the BBC report is rubbish and click grabber, but the facts are there that there is a huge issue in maternity services across the country.

Staff being selective in the amount of care they provide to mothers on maternity wards was absolutely my experience at my local hospital. And that experience was shared by many people I've met (both from the perspective of those who received extra attention, and those who were completely ignored like me). Race was not the only factor, but I can't deny others experience that it was for them.

No one is saying it's the case everywhere. I also had a really good pregnancy and birth experience in a different hospital, where I did not observe any discrimination. They also had much better organisation and processes, so it wasn't just done to the individuals, the entire system was built to work.

Except research clearly shows much poorer outcomes for women of colour. If it were purely a resourcing issue, then all races would be affected proportionally but that isn’t the case. Todays report isn’t news in that it’s long been reported that outcomes for black women particularly are much poorer, how do you account for that?

Unfortunately, I have seen from first hand experience the disdain towards BAME patients. When I laboured over 48 hours with my first born and having to be induced with other women all crammed into a small induction room in pain and feeling dismissed by a white midwife telling women to ‘just lie down’. No compassion, no warmth just midwives irritated by women needing support at a time of day where visiting hours had long ended so these women were alone. They were obviously in a lot of pain and struggling after being induced using hormones and pleading for pain relief. It’s one of the most terrifying experiences I have encountered and it took a long time for me to consider having any more children due to the fear and worry about the lack of compassion at such a vulnerable time. Although I attended every single antenatal appointment and also privately arranged my own care when I needed to expedite scans etc I can understand women who choose to avoid antenatal care or stay at home as long as possible for the fear of how they will be treated. Thankfully my subsequent deliveries were better than my first, certainly not perfect but more supportive and compassionate midwives

Im not really sure why what I think (as a white woman who hasn't been near maternity services for 15 years) would be more valid than an interim report from a government commissioned review.

So therefore I think its best to listen to the findings and push the government to take action on all 6 areas mentioned. If we decide to only listen to the finding we find comfortable we are not going to make birth safer for all women..

So depressing that you have made this thread, OP. Don’t you see part of your job as narrowing this gap in outcomes? As an educator, I do.

Is this just the experience of BAME women though? I was so traumatised by my lack of care end to end from induction- c section - maternity ward by actually BAME midwives that I had my next babies by elective c section.

As people we all have biases. Many that have been placed in our subconsciousness through films, books and tv.
Additionally some cultures do act differently towards pain and emotion. Think of funerals comparing the stiff upper lip" of middle class British men. Where it was socially expected to hold in emotions. Compared to an Irish wake. Where openly talking about the person who has died is encouraged. This translates in the way, people respond to pain, and in turn has created biases about levels of pain.
Treating people differently because of their culture.
Lots of research has been done across the medical profession to see that this is an issue. And this is still an issue with
Medics of colour, giving worse treatment to people of colour. Because those ingrained biases aren't just put into white people's heads.
I know a lot of medics and many want to try and address this.

There is research showing that the experience of BAME women is worse.

Why can you not accept that?