Guest post: "Black women are four times more likely than white women to suffer a maternal death. Practical steps for safeguarding your rights in maternity care."

[JuliaMumsnet]

Evidence repeatedly shows that black, Asian and mixed ethnicity women are more likely to die, experience baby loss, become seriously unwell and have worse experiences of care during pregnancy and childbirth, compared to white women, in the UK. Birthrights charity is convening a national inquiry into racial injustice in maternity care. Solicitor Olivia Boschat, who is working to support Birthrights in their national inquiry, recommends some key steps women can take to safeguard their rights during their experience of pregnancy and childbirth:

"Your rights

Every person has the right to receive appropriate healthcare, whether privately or through the NHS. The right to safe maternity care is fundamental to the wellbeing of women, their children and their families.

Women have the right to equality, which means that they should be free from discrimination. Appallingly, this isn’t always the case. There is repeated evidence of racial inequality and injustice in maternity care in the NHS going back many years. There’s also a clear link between the number of women dying during and following pregnancy, and their racial background.

I hope to provide some practical advice so that women can know what their rights are, what steps to take to minimise risk of harm and what to do if things go wrong.

Making decisions

All patients have the right to be involved in decisions about their treatment and care. In order to be able to do this, patients have the right to know the risks of each procedure and the alternatives to it.

Medical professionals must support women to make informed decisions. Women have the right to be listened to, and to be given the information they need to make a decision. They must be given the time and support they need to understand the treatment, alternatives and consequences.

Medical professionals must, by law, gain informed consent before carrying out any form of medical treatment, unless the patient lacks the legal capacity to decide.

This means that if you don’t understand something, you should ask for it to be repeated. The doctors and nurses caring for you have to explain the treatment to you in a way that you understand and give you the time you need to consider the options. You’re not being a nuisance. You have a right to ask.

Practical steps to take

For many people, any form of hospital or doctor’s appointment can be nerve-wracking. When pregnant, women are more vulnerable and it can be overwhelming. Coronavirus has amplified the anxiety and stress involved with many women not being allowed to bring a partner or person to support them during antenatal or postnatal appointments.

I recommend anyone attending an appointment to jot down questions beforehand. There’s nothing more annoying than remembering a question when you walk out of the appointment room, and having unanswered questions can increase anxiety. Having a note of questions in advance can help jog your memory and make appointments less stressful.

A great tip is for you to take note during the appointment of key points the doctor or nurse has explained. If you don’t understand something, ask for it to be repeated. This is your medical care and you have a right to understand it.

Try to carry out some research online via organisations and charities to gain knowledge about pregnancy, what can happen and your options. The charity Birthrights has abundant advice and resources to equip women and families during and after pregnancy.

The organisation Five X More has identified Six Steps that pregnant women can take to help minimise harm.

What if something has gone wrong?

If you’re worried that something has gone wrong in your medical care, I strongly recommend you ask questions so that you can understand what has happened.

The first step I recommend is to request a copy of your medical records from the hospital you’re being treated at. Medical records should be kept for all patients having medical treatment. In a maternity setting, they will be completed by midwives and doctors. You’re entitled to see your medical records.

Each hospital in the NHS will have a medical records department and procedure for you to request your records. You may be asked for a signed form to access your records, but you shouldn’t have to pay for them. Getting your medical records may help you to piece together the medical treatment you received.

If you’re worried something has gone wrong, you may wish to make a written complaint letter to the hospital to ask questions. There’s no shame in doing this. Each hospital has a Patient and Liaison Service (PALS), and they can give you access to the hospital’s complaint procedure and help you to understand what has happened.

I would urge anyone who thinks something has gone wrong in their medical care to reach out and speak to charities for support and guidance. In particular, the charity Birthrights supports and campaigns for women and families during and after pregnancy. They have recently set up a national inquiry into racial injustice in maternity care.

This inquiry will investigate how racism in the NHS is adversely impacting mothers and babies, and maternity care as a whole. The aim is to determine exactly what needs to be done at all levels to effect change.

Legal claim for medical negligence

As a solicitor specialising in women’s health, I sadly see the impact of medical mistakes on individual women and families. I assist women who have suffered physical or emotional injuries as a result of substandard medical treatment. I also specialise in helping families when their child has been seriously injured during labour and birth. I help families to get justice when the negligence has caused death.

The aim of a medical negligence claim is to obtain compensation (money) from the opponent. In order to win a medical negligence claim, you have to prove that:

1. The medical treatment provided was so poor that no other responsible body of medical practitioners would have provided it (this is called breach of duty); and

2. This breach of duty caused a significant injury which should have been avoided had the treatment been legally acceptable (this is called causation).

A legal claim for medical negligence is not a route anyone really wants to pursue. Every client I’ve represented would much rather the negligence had not occurred. For many injured people, the damage has cost them not only physically and emotionally but also financially.

While money can very rarely compensate a person for the extent of the injury suffered, it can help with recovery, medical treatment and support for the future.

Olivia Boschat is an Associate Solicitor in the Women’s Health team at Bolt Burdon Kemp and can be found on twitter here @omitchisonbbk**

@Veex21

My twins died after premature rupture of my membranes. From the moment I was wheeled into the hospital I was treated poorly. I even heard a nurse outside my door bad mouthing me to a doctor (that I was giving it the biggun by not having pain meds but now look at me), I was left with a student midwife, criticised about my ivf choices, told that I already had a son so losing my babies shouldn't be too bad. It even went down to my babies being taken away without me seeing them until the next morning. I could keep continuing.

I complained to pals and what I got was a 'lesson will be learned ' as well as nurses and drs saying they didn't say or do that. If they had made me a priority when I got to the hospital 1 or both of my babies could have been saved. I didn't lose my life but I very nearly did.

I'm sorry to hear this story, how bloody devastating it must have been for you. Words fail me xx

[quote Eastie77]@EKGEMS well that's the point, all women should receive top notch care but non-White women tend not to, hence the disparity in outcomes. You are a White women and thankfully experienced great levels of care when you needed it but it could have been a different story if you were Black or Asian.

There is really no need to turn this into a "All Women's Lives.." debate[/quote]
I agree, the worry here is BAME mums, not all mums.

I would also like to see impact of the disparity in type 2 diabetes across the population assessed within these studies.
If more women in a particular race have type 2 diabetes (or undiagnosed metabolic disorder) what is the effect on infant mortality from that condition?

*Well dead baby is often a risk of decisions mothers make. They are only making it clear that it's a risk. Would you rather they didn't tell you?

There are ways of discussing and imparting statistics and facts without deliberately attempting to manipulate and coerce the outcome.

Individuals will express differences of opinion and there is an overwhelming lack of willingness or acceptance of responsibility to respect that.*

Yes, there is always a risk of losing an unborn child but when consultants are coercing you into procedures that actually put you and your unborn baby at more risk and/or refuse to give you evidence for what they’re doing or that evidence isn’t particular to your situation then there’s a problem.

The head consultant had planned to induce me at 36 wks when I was 20 wks because baby looked small, she said it may be due to a chromosomal defect because baby was mixed race so an amnio was needed. My hub and I are on the slender side, athletic, both small as babies and children. None of our mothers had a baby bigger than 7.5 lbs. My family is mixed race so never heard such a thing nor any issues so got a second opinion. A fetal specialist said an amnio was unnecessary and invasive. Month passed, baby too big to her, induce. She took over my care from the community midwife. I asked the cm why, she said that was what she was told. I’m not from the U.K. so thought it was part of procedure. Refused to be induced for weeks because no evidence or reason why beside baby “looked” big. Even sonographers were telling me baby was healthy and didn’t understand the fuss. She sent three different consultants from her team to push me to induce telling us I was killing my unborn baby and sprouting statics for stillbirths (outdated and unrelated to my case, I found out later). I caved. 3-day induction, 3 cm dilated, failed, emcs and a baby that wasn’t breathing. A registrar yelled at my husband in front of me and other hcps in the room assuming he was stopping me from talking to her (he wasn’t, he was supporting me in the middle of a contraction), one of the consultants I had previously yelled at me to hurry up because she wanted my room for someone else. Son was a whopping 6lb 13 Oz. Reported them. Hospital went through my notes, no medical need or reason to have induced me in the first place.

I suffered birth trauma, ptsd, anxiety. My husband was traumatised and didn’t want another baby because of what happened. We did have a second, healthy, no issues, and went into labour on my own. Same hospital but with hcps that listened, I was more informed and wasn’t taking any sh*t.

Our oldest son is disabled and we are reminded every day of what they did.

One thing that isn’t mentioned by any study (but which caused maternal deaths at Milton Keynes) is that it was female BAME midwives and consultants who under-recognised the pain of their compatriots. I was told by many female Indian and black consultants and mw that I was too anxious, making too much of a fuss, they tried to use ‘familiarity’ and our shared culture to shut me up.

All but one of the HCPs I had with my first were older women. The head consultant was Asian as was the consultant who yelled at me. The registrar was an older white woman. The women who were my age or around it at the time (late 20s) were much nicer and listened.

@KeflavikAirport

Presumably this is only within the UK context. Worldwide the vast vast majority of the women who die in childbirth will be black or ethnic minority.

In a world population context people who aren't white are the ethnic majority.

In other words people of white ethnicities are ethic minorities globally.

Yes I am picking you up on your language because language like this is linked to thought processes and actions that causes black and brown people harm. Remember this thread is on why black and brown women suffer higher fatalities and injuries due to maternity health care.

For such an important topic, this thread is very short...interesting..
They tried that forced induction with baby death threats with me but a dula gave me advanced warning of this unprofessional practice and I refused unless they could give me good reason. Even the receptionist joined in the bullying but I stood firm while watching women in agony for days after being induced. Then they tried to ignore my birth plan and not give me pain relief until they thought I was in pain. I kicked off big time so they had to work to the birth plan in the end. Then they tried inducing me behind my back when I was asleep but my baby reacted badly to it so they had to stop. I made an official written complaint. You have to go in informed and shout the loudest. I knew about all this and would not let them use me anyhow they wanted. My baby came bang on his due date despite the crap they were spouting and was healthy. He now has significant allergies and I wonder if there is a relationship between that and the sneaky induction drugs they tried but he rejected. Don't let their "professional titles" change your instincts or judgement unless there are clear reasons for action/moving from your birthday plan.

Erm did you miss this report in December that called for sweeping changes to all maternity services in England, Bagamoyo? I'm a huge supporter of the NHS which is why I want to see more money go into maternity services (which have clearly been understaffed for years).

@GrumpyHoonMain

One thing that isn’t mentioned by any study (but which caused maternal deaths at Milton Keynes) is that it was female BAME midwives and consultants who under-recognised the pain of their compatriots. I was told by many female Indian and black consultants and mw that I was too anxious, making too much of a fuss, they tried to use ‘familiarity’ and our shared culture to shut me up. But funnily enough after my baby’s life was saved after the interventions I demanded none of these women even wanted to see me to check how my baby was.

So my advice would be

Totally with you on this one.

Hi ladies

Had a colposcopy yesterday no biopsy's taken
tmi but had light brown discharge what looked like coffee grains and light bleeding today the bleeding is heavier like a period don't remember having this last time?

To those who have had devastating experiences. All women have a right to be listened to. And believed.

This is an article written from a legal rather than clinical perspective though. It's not my area of practice, but I would prefer to see advice from patients, families and experienced Health Professionals. We should be promoting safe birth and positive experiences for mothers, not driving people towards lawyers.

Lovely to see you all having a good old bash at the NHS.
Most of you have no idea of the stresses of working in healthcare.

Talking about our experiences dealing with the healthcare professionals we personally had is not bashing the NHS, it’s bashing those specific healthcare professionals and rightly so.

Why is it that no one can complain about poor healthcare that they experienced without the accusation of tarring the whole NHS system?

@Bagamoyo1

Message deleted by MNHQ. Here's a link to our Talk Guidelines.

Things do go wrong in the NHS and this kind of overly defensive culture is exactly why I stopped working in it. There are lots of good things in the NHS but there are also plenty of bad ones too. The arrogance of people suggesting that we just ignore those issues is sickening to me. There are a number of maternity units that are judged as unsafe by the CQC, that needs to change.

As is the "All women" perspective people are giving out. As a white woman who had an awful birth where there were failures that meant that not only did I end up with sepsis and my kidneys failing but my son was also having to have treatment, recognising that BAME women are more likely to have such a birth doesn't mean that I feel like my experience isn't important, it is. I probably was just unlucky but it seems that some women are getting poor card because of the colour of their skin and that is a major problem.

I’m certainly interested in the results that the National enquiry come up with. Assuming they get some.

Currently we know that in the U.K. BAME women are more likely to die in pregnancy/childbirth but not why.

Is it due to BAME women being biologically more susceptible to certain conditions such as diabetes which increases your risk. Afro-Caribbean are also more likely to have a PPH (is this down to biological factors or sub standard care).

Is it due to language difficulties for some BAME women and the nhs not using translation services as they should? Then women not being aware of various warning signs, not knowing who to contact, not telling people symptoms?

Or is it due to HCPs not listening to BAME women when they do disclose symptoms, when they do talk about pain,etc due to racism?

Or is it a combination of all of these?

Vitally important that we know as the changes which need to be made are different depending what the cause is.

What I find really sad is we’ve known for years that BAME women are more at risk, at least ten that I know of! And the enquiry to find out why has only being kicked off recently. It’s a disgrace.

Advice much needed please.
I’ve been married for my husband for over 10 years.
Throughout that time we have had three children and I think the world of him.

However all is not the same for my husband.
He has slept with numerous women during the course of this but, the worst has just been discovered that my husband has been having an affair with his boss for over 2 years.

He’s been leading a double life with his other partner. Told her that we are divorced but, live together for the sake of our children.

I found everything out and this was now the final straw.
I am now wanting him to get out of the house .
He simply won’t go.
The mortgage is in joint name and I run my business from home.
He has said he will buy me out and I should move out with the children and get the council to help me.

I am utterly exhausted mentally and physically.

Please if anyone can help me with legal advice etc I’d be very grateful

@emmskie03. Sorry to hear that, you might want to start a new thread on the relationship board....you’ll get more advice. Sounds like you need a good solicitor.

Sorry, tagged wrong person. @Em4891

I’m amazed you’ve deleted @Bumblebee413 post. Iirc what they had said it didn’t break any guidelines. 🤷‍♀️ I think they had a valid point.

I suspect this thread isn’t to support black women or drive discussion though, but to direct us to the ambulance chasing legal team....and they’ll happily take your money whatever colour you are...

I was thinking exactly the same thing Micah

My heart goes out to anyone who has ever been affected by mistreatment at this time which is so so precious, it is truly awful. Has any legal case for neglicence against mentioned staff or hopsitals involved ever been made? This should not be happening

I had my ds two months ago and my delivery was absolutely awful! My husband was with me but i feel i encountered racial bias - the only time i felt seen about after being shunted into a side room after heavy blood loss and a manual placenta removal in theatre after artficial oxcytocin and spinal left me with severe diahorhea was by a black midwife! She made sure i had my pain meds even though id asked for them and helped me get a shower. As a black british person in a multicultural city womens hospital i didnt expect the treatment i got.

@Nooshyb

I had my ds two months ago and my delivery was absolutely awful! My husband was with me but i feel i encountered racial bias - the only time i felt seen about after being shunted into a side room after heavy blood loss and a manual placenta removal in theatre after artficial oxcytocin and spinal left me with severe diahorhea was by a black midwife! She made sure i had my pain meds even though id asked for them and helped me get a shower. As a black british person in a multicultural city womens hospital i didnt expect the treatment i got.

Bless you, that must have been so horrible..That artificial oxytocin hurts like heck. Brutal contractions. One loses any form of 'Dignity' after childbirth anyway {I'm White}, but my first experience of childbirth put me off ever repeating the experience. {Rough White male Dr} I was young, and didn't stick up for myself, and husband was asked to leave the room art one point.