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 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.

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'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?

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

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.

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.

And are racist themselves....

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.

@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.

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.

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.

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.

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?

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 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.

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

But everyone is assuming this, sadly.

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.

You are missing the point that if all midwives were less rude or more polite and dealt with all women more kindly, there would be far less bad behaviour that may or may not be construed as racism.

Exactly. The OP is worryingly ignorant for a healthcare professional - I haven’t seen racism therefore it doesn’t exist??

Couldn't agree more with this. I'm an NHS clinician myself, although not in women's health. Training courses are often seen as the answer to everything. Its a quick, relatively cheap tick box exercise that means we can kid ourselves that we're doing something meaningful about the problem. There is some excellent training on offer, but I don't know how you 'train' professionals out of cruelty and coldness, or how training would prompt someone to reflect on the frankly chilling behaviour that we've seen shared on this thread and elsewhere. While I fully recognise the reality of compassion fatigue and the brutalising effects of working in such a broken system, there is just no excuse for some of the stories that women have shared about maternity care

The existence of systemic racism and misogyny cannot be denied. NHS staff are just regular people - the 'angels' and 'heroes' narrative is profoundly damaging and downright patronising. We need honest conversations, hard decisions, transparency and proper funding, not claps on the doorstep. Huge cultural change is needed to move HCPs away from the 'us and them' mentality that does so much damage

I completely and strongly disagree with you, OP. You’re teetering on the edge of “but not all..”.

There is clearly a big problem and the problem is with people, it’s not about denigrating a particular job.

The 6 factors identified are:

• *Services depleted or stopped because of capacity pressures, with stretched antenatal wards and delivery units resulting in delays to admissions and the use of community midwives in delivery units impacting safety
• "Poor relationships" between team members, including obstetricians and midwives. Racist and bullying behaviour of senior clinicians was not always dealt with by management
• 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
• A lack of compassion and transparency when baby loss and harm occurs, which can lead to mothers wrongly blaming themselves, compound trauma and impede opportunities to learn from mistakes
• Care being delivered in outdated and dilapidated buildings, in some cases compromising clinical care. Bereavement spaces were insufficient or non-existent in some trusts
• Staff reporting maternity units did not have enough personnel to provide safe care*

These are serious matters and the structural racism identified is clearly harming women, apart from being repugnant. There’s a trend now to make acceptable such behaviours as racism and antisemitism.

Why is it only the identification of the racism factor that bothers you? Why highlight just that one in your heading?

Are you seriously suggesting that because you haven’t noticed anything, it isn’t a problem? That there was no need for a report because they could have just asked you?

So as a white person who would really rather not upset anyone, what is a better term? I’m being serious not snarky.

It looks like the BBC headline is extremely poor. The issue doesn't appear to be racism, but that's what the BBC fixed on