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.

Sorry you had such a bad time. I do think midwife services in this country can be terrible and let many women down.

The research isn't saying, all white women will get good treatment. It's saying the service is below parr and disproportionately women of colour get worse treatment to their white counterparts. Don't know if the research has ever been done, but I bet equally middle class women get better treatment and working class women.

This doesn't mean individuals who are white and middle class won't get shit treatment.

Agree 1000% with you. The MBRRACE report comes out every year looking at illnesses and deaths in pregnancy and the year after giving birth. Many of the patients who died were under the care of multiple specialists, not midwives. For instance, some had cancer, heart attacks, very high blood pressure, blood clots, bad COVID requiring hospital care,severe mental illnesses. They weren’t a fit bunch in the first place and IMHO midwives need to be formally trained in general adult nursing (to know about these conditions and other common medical issues like diabetes outside pregnancy) to look after them properly. A few obstetric medicine lectures as part of joint multi-professional teaching aren’t going to cut it.

I've seen it.
A black woman reporting pain in her leg, and ignored by a multi ethnic multidisciplinary team, accusing her of lying so her baby would be born in the Royal Borough of.... As if that's an actual thing?!
She was eventually diagnosed with PE. She knew something was wrong and was ignored by Indian doctors, British Jamaican and White British
Midwives.

A team of all black midwives, with heritage from Eritrea, Nigeria, Jamaica, screaming at a Sri Lankan woman birthing an OP baby that she was weak. Once out the room, a discussion where they all said that Asian women were dramatic. The way they crowded over her, bullied her into pushing, inches from her face still pisses me off.

A whole shift of midwives at handover, of all ethnicities, saying they didn't want to care for a young white woman because she was obviously a teen mum, from the wrong part of town, etc. I was the student given her, like the last kid picked at PE. I walked in the room and she was older than me for crying out loud.

We are product of our own prejudices. All of us. Too many allow them to get in the way of providing care to women that need it.

I think the OP is confusing structural racism with explicit individual racist attitudes. The existence of structural racism is established on the basis of research that demonstrates poorer outcomes for Black people and other minority ethnic groups. The reasons for it will include things like unconscious bias in the perception of pain, and (say) funding policies that have unintentionally led to hospitals treating diverse populations being less well resourced than others (that's just intended as an example - I don't know what causes the research actually points to. Another factor might be the effects that unconscious bias has on the recruitment and retention of talented and highly trained Black staff)

These disadvantages for Black patients and other minority ethnic groups are already well-established and have been in the news quite a bit over recent years.

I trained years ago and these attitudes were very prevalent then! Black women can handle pain and Asian women always make a fuss! Its saddening to see that nothing has changed!

I agree with you op. I think obviously while any genuine racsim needs to be taken seriously and dealt with, there should be consideration for other reasons why some minorities have poorer outcomes.

You mentioned language barrier as one. My friend is a midwife and she told me she has had a number of patients who don’t speak English but also bring their husbands in and they can’t get a word in even with an interpreter, the men are speaking for them.

This thread shpws againwhat I have been reading in other places on mnet particularly on some of the tourettes thread where lived black experience is being dismissed. The ongoing racism even if it is from unconscious bias and systematic failures is shocking. And nobody is helped if we ignore that.

Working in education myself we have to be aware of our own possible bias and question if that impacts our practice. Being defensive, minimising and ignoring the reality wont help anypne least of all those we care for.

This impacts people with disabilities as well. The inherent racism and ableism and the 2 came together on the tourettes threads where some minimised and ignored the hurt words can cause. I say this a parent of a child with tourettes btw. I see ableism myself because supporting disability is my job and I have a child that lives it. But I can also recognise I have white privilege in navigating the systems and wider society.

I have tried to read the boards a bit and look at the experience of black women on here and to see yet another thread where black voices, black lived experience is being ignored, minimised again shows the inherent biases that we arent aware of.

It makes me really sad, we all have beliefs, bias and assumptions that we pick up by merit of the society we live in and the systems we are part of, we do ourselves and minorities a huge disservice by ignoring that.

This doesnt just impact midwifery, it has been shown time and again in other areas of healthcare, education etc.

Attitudes like yours op are part of the problem.

Based on the people I know IRL, i agree with all of this.

I have a very close Indian friend who is shocked at the care i received postnatally and described how in Indian culture, the mum is looked after really well and stays in bed and is allowed to rest and has lots of people to help.

As soon as I saw the term “BAME” I knew this was a losing thread.
Using that term is part of the structural racism present. Lumping anyone who isn’t white in a collective term.

Midwives, whilst they do an amazing job, are just human. There are unconscious biases, lack of training and awareness everywhere.

I didn’t experience this during my time in hospital but the midwife checking my son had to get a second opinion from a more experienced nurse to check my son’s jaundice as the very light brown colour of his skin made it confusing for her to confirm if he had it.
That’s not her fault, that’s a lack of experience.

Structural racism does not mean individual staff are racist. It is about how services are delivered in a way that disadvantages particularly groups. At no point does this report say midwives are racist - although they should have defined what they actually meant.

It exists and is happening. Both individual racism and systemic failures exist.

By denying it you are part of the problem.

I had the complete opposite experience. Wonderfully kind, empathetic care from several BAME midwives, and belittling, dismissive treatment from two of the white midwives who failed to listen to what I was telling her and ended up putting both me and my dd at risk.

I find it's generally best not to make assumptions about entire ethnicities based on very limited experiences of just a few people.

How dare you demean her experiences because you had the opposite experience.
Why do your positive experiences outweigh her bad? Why is yours more important?

Do you have a reading comprehension problem?

I haven't demeaned her experiences in any way at all, and I haven't suggested that my experiences are more important either.

I am merely pointing out that anecdote does not equal data, and it isn't fair to make sweeping generalisations about BAME midwives in general, simply on the basis of your own personal experience with just a few individuals.

If you are incapable of understanding that point, then that reflects more on you than it reflects on my post.

This is a perfect example. If the midwife hadn't realised her lack of experience and confidence, a jaundice diagnosis may have been delayed. That midwife wouldn't say she was racist. But the system she is in is structurally racist in not ensuring she is trained to deliver equal treatment to all patients.

I really do not like the references in the OP & subsequent posts to ‘hard working’ midwives & staff.

People are absolutely not exempt from criticism, or from the need for improvement, just because they are ‘hard working’.

The aggrieved implication that ‘hard working’ staff are exempt from criticism is, I think, very revealing of a problematic and unattractive attitude in the NHS - an attitude which could be described as ‘We are noble and beyond criticism’.

This attitude is feeding into both poor standards of care, and the defensiveness & concealment that stand in the way of improvement and openness when things do go wrong.

I’d go so far as to say that these posts are, unconsciously, very revealing of the problem that needs to be dealt with.

It’s not about making ‘sweeping generalisations’, it’s about acknowledging that minority ethnic people have worse outcomes, and accepting where things are going wrong and changing them.

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.”

Even if that is true, and I don’t know if it is indeed a cultural practice or a massive stereotype, how on earth will problems in labour be picked up when these ladies are ignored and dismissed?

I'm a white, middle class, professional woman. When I had my first 31.5 years ago, West London teaching hospital, I was shouted at for groaning at 1cm and laughed at, by a white middle class midwife (I found out later it was a posterior presentation).

During my ante-natal, labour and post natal care, I was shouted at by two white midwives, two black midwives were dismissive, one of whom was vile and offensive, and provided poor advice. It was a white midwife who failed to realise the baby was being strangled by the cord - the third time it was blamed on a faulty belt, DH intervened, open the door to the delivery room and shouted for a Dr RIGHT NOW. Cue red button and chaos - it took a long time to resuscitate DS.

Frankly if there were more competence, professional behaviour, listening and basic good manners across all forms of maternity and women's care generally, there would be fewer assertions of individual and/or institutional racism.

It was different when I had DD. Partly a better hospital, but I'd done it before and was crystal clear in relation to my expectations. She was delivered by the best and kindest ever midwife from Senegal who I had never met before but within ten seconds she made me feel safe. Hawa, Kingston Hospital, if she's about.

As a white woman, I found too many midwives to be rude, judgemental and dismissive. If they can find something to be rude about they will be.

Absolutely. The report is not about sweeping generalisations because it's based on carefully researched data and not just anecdote.

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.

Absolutely this.

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.

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.

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.

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.