Pregnant with a black/mixed race (with black) baby

[Sugarintheplum]

Dear All,

I am a pregnant black woman, not for the first time, and I'm just wondering about other people's experiences.

I've had some very different experiences, some quite stark. In one pregnancy it never really seemed to come up beyond booking and the sickle cell test etc. In another my midwife talked quite openly and a lot about the differences in black and white women's anatomy and how this might impact pregnancy and labour (she herself was European, Italian, I believe). At first,I found it a little disconcerting, my blackness being referenced, but at the same time I appreciated the personalisation and attention to the needs of black women. Ultimately, I was grateful. Oh, and there was the Other time when during a sweep the midwife commented on my baby's lovely black curly hair and I was there, legs open thinking 'seriously, you're ALREADY touching my baby's hair now?!'

She told me, for example, that babies of African-descent typically have a shorter gestation period (around 39 weeks) so she'd keep an eye on me if i went overdue (as in 40+ weeks) because in fact my baby would be more overdue than non-black babies and need to be monitored more carefully. Do all midwives even know this? Ad other things like, for example, our pelvis is shaped differently so the baby's exit is different (though the NHS does not accommodate for that in their utensils and tools).

So, I'm wondering what other women's experiences are if you are not a white woman, but the NHS and maternity care is modelled on that of white women, and if your baby is not white, but the NHS maternity care is modelled on white babies.

Hopefully we ca share some experiences and empower ourselves or others we know when we or they become pregnant in future!

Following as non-white woman - sounds really interesting, thanks for posting.
Can't say much as I've only experienced the booking/sickle cell test and in my hospital we're offered the BCG vaccine as routine. My area is about 50% South Asian ethnicity though.

I've only experienced the booking/sickle cell enquiries and the midwives never made any comments regarding the difference in black and white women's anatomy.

Your comment regarding African descent babies having shorter gestation periods is very interesting and probably rang true with both my pregnancies; DC1 arrived at 40+1 weeks but there were complications due to placenta probably stopped growing while DC2 arrived at 39 weeks but ended up in NICU for first 8 hours due ingesting meconium.

Is that actually true? Anatomy, etc?
Have you found evidence other than being told about it by a midwife?

the one thing I know is true is that if you are of African descent you are far more likely to have twins -
academic.oup.com/ije/article/33/1/107/668109
however -I did a search & this came up! interesting because it says exactly what your midwife says!

black (and some Indian) babies are also more likely to have higher NT thickness (along with a short nose bridge) so scans to spot Downs may not be effective. You can often be advised to go straight for a CVS or NIPT then CVS if you want a risk based result first.

My research (mostly American based so may not apply in the UK where a lot black women have African origin) also suggested that the cervical length for some black women is shorter due to hip shape which is what causes early labour, and that black women are also more likely to have this (and thus have smaller babies). However the NHS doesn’t tend to offer routine screening for this unless you had a problem with this previously.

Also black / Indian woman are more likely to get gestational diabetes and preclampsia and so have smaller bump size / baby size tolerances. And less likely to have babies with certain genetic problems (cystic fybrosis for example).

But all of that applies to women who aren’t mixed race. If you are mixed race nobody should be using race based models with you - they should be treating you individually. My guess is your previous midwives treated you like a black mum to be to be on the safe side and ensure you get extra monitoring earlier (as I said earlier smaller tolerances for any problems).

I have read about the pelvis shape one when I was in my madly-researching-everything phase in early pregnancy.

DH and I are black, but he's Black British/Nigerian and I'm Black British/Caribbean.

He has Sickle Cell (although he's very healthy, thank God), so I was fully tested for sickle cell by his hospital staff before we were even married.

We were told black African babies tend to be bigger, but not by a midwife, but this tends to be a cultural belief. Our son was not a big baby. He was closer to my own birth weight, but DH's sisters all had big babies and most of their DC were overdue. DS was only a day overdue.

Re anatomy, I'd want to see evidence. I have cousins with big hips but they actually have a small pelvis which became problematic during birth.

So basically, nothing to report. I have an amazing Irish midwife, who is rather senior and has been a midwife for decades. She would have told me anything I should have known if it were important. She told me DS would be tested for Sickle Cell, and that he'd be offered the BCG.

If you are mixed race nobody should be using race based models with you - they should be treating you individually. - I was wondering about this recently. My sister is pregnant and midwife has recommended she has the GTT due to ethnicity (mixed white/Black Caribbean), and I wondered how much of a robust breakdown there really is for the stats on these sorts of things.

I am white, but my children are half-African, and nobody ever mentioned the shorter gestation thing to me - they were born at 39+6 and 38+5. Midwife for my second was convinced I would go overdue and started offering me a sweep, quite insistently, from 38 weeks.

I'm not black, but one issue I've heard about is Mongolian blue spots, this is a kind of birthmark which is more common in darker-skinned babies. Unfortunately it looks like bruising and there have been cases of HCPs not being aware of this and parents accused of child abuse before the truth comes out. So it is worth being aware of it and if your baby has it being prepared to explain about the condition to health professionals.

There can also be a problem with spotting jaundice in babies with non-white skin tones - they should be looking at the whites of the eyes if unsure.

@NellWilsonsWhiteHair - the GTT scan is based on the risk for black women I would bet as half white / half Indian women also have to have the GTT scan (and some even get offered proactive preclampsia treatment) due to the risk for Indian women.

Mongolian blue spots often get checked for after birth but can be difficult to see on darker skinned babies, or emerge later. This is another reason why it’s a good idea to stay for an extra night in the hospital if possible.

Hi All,

Wow, a lot of responses in short period. I'm learning. I'm currently pregnant so will look more into tests for Downs being less accurate. I find so much of this stuff frustrating. The information should be more readily available.

Re pelvis size etc being true - I think they covered this in the Woman's Hour on Black Maternal Health recently: www.bbc.co.uk/programmes/m0006zlb

Hopefully there will be more responses and we can share more between us. This will be my last pregnancy, I expect, so I'll be passing all of this info on.

About shorter gestation period, yes. I track my ovulation so I'm pretty sure of O date, and each pregnancy they have put me forward 4 or 5 days by 12 week scan, when there is no way. I also had babies on the small-ish side (6 or just 7 lbs) so talk about black babies being bigger I expect is a more stereotype...

Both of my babies had Mongolian blue spots, my 2 year old is just losing hers on her face.

There is also vit D deficiency which can result in what looks like bruises etc on babies, when it's not. This happens to white mums too, but lack of vit D is a definite issue for darker skinned women.

@jennymac31 "DC1 arrived at 40+1 weeks but there were complications due to placenta probably stopped growing while DC2 arrived at 39 weeks but ended up in NICU for first 8 hours due ingesting meconium."

They really should have been monitoring closer. You can't be alone in this.

oooh, sorry, and about shorter gestation periods. This also means black babies are more likely to survive when born prematurely, because they have matured their organs quicker. But on the other side, yes, far greater risks when overdue.

I’m caucasian but had a mixed baby (half Asian) in an Asian country. My body type is also very different from Asian women, for example I had gained much more weight then the average Asian pregnant woman and my baby was also bigger. Doctor openly discuss differences between pregnancies in women from different ethnicities with me (for example told me that Caucasian women had a wider pelvic bone opening then Asian women) and assured me that despite my more then average weight gain, I didn’t look fat to him so he said it was OK.
My advice to you would be to speak up if you have questions or feel uncomfortable re how your pregnancy is treated based on you being Black and just enjoy it and not worry too much

I usually read on here babies being described as 'underweight' at around the 5 pound mark although IME that's quite normal for Asian babies and have been told by midwives as such.
I was automatically selected for GTT despite having no family history and TB jab despite having hardly any family abroad (baby is 4th generation British Indian) or planning to visit India. Only ethnic minorities are offered TB jab in my area regardless of history.

I also found this article that seems to suggest there's some truth to the anatomy differences. But the study was done on African Americans.

www.ncbi.nlm.nih.gov/pmc/articles/PMC2593128/

The thing is that there isn't one "black race". Genetically, Africans vary a lot. What may be true for the African Americans tested may well not apply to many black women.

There's also something called ecological fallacy. It means that we shouldn't treat individuals like the group they belong to.
More so because of mixed ancestries. So, every woman should be evaluated on her own, not according to her "race" - meaningless term.

Don't know if this is relevant but DS was very jaundiced (not sure of that's a word, but you know what I mean) and they ignored it thinking it was just his skin tone. I'm South Asian, but he's mixed and I knew his colouring was way too yellowish in tone. They ignored this, and a week later had to back in after I had him and his bilirubin levels were high.

Also the BCG vaccine was brought up.

@Llewi,

Agreed that race is a social construct. Every woman should have the size of their pelvis assessed, along with the shape of their birth canal, and there certainly are some white people out there with sickle cell, and some African babies with cystic fibrosis etc...

My understanding is that if a particular condition or issue does not crop up often outside of a pretty narrow model of pregnant woman based on white British women, it's not often fully considered in our NHS.

This is not even really considering how some women feel ignored, or overlooked, or treated badly because of their culture, which I've also heard a lot about. Racism is everywhere, no reason to think it does not crop up in medical research on expectant women, or in their eventual treatment in antenatal and maternal care.

Racism is everywhere, no reason to think it does not crop up in medical research on expectant women, or in their eventual treatment in antenatal and maternal care.

Indeed it does.

The woman's hour was really quite upsetting in places. I'm not a parent and white so don't want to dominate the thread. This made me think of my sister's experience recently. Her husband is Indian and they couldn't seem to get their head around the fact the baby was small because Indian babies tend to be small so because the baby was mixed race it might be small. Also the baby had jaundice which was missed because the baby has dark skin. So I can't imagine if little things like this seem to be beyond maternity care then what the experience of black women is. Obviously the women's hour programme gave me an idea. Thanks for sharing your experiences I've learned things I didn't know. Which make the uniform care even more shocking.

My sisters other child had Mongolian blue spot and hardly anyone knew what it was and just thought it was a bruise!

this is a really interesting & useful thread, thank you @Sugarintheplum!

do you ladies think the level of knowledge & understanding of these issues varies depending on where you live? I live in north London and I guess I'd assumed if my baby or pregnancy needed any specific knowledge due to the baby's ethnic mix (I'm white, baby's dad is South Asian) then this would be the place to be because most of the babies being born at my local hospital must be Black, Asian or mixed! So presumably the midwives are experienced and wouldn't be thrown off by things like birthmarks/jaundice presenting differently in darker skinned babies...??

I was recommended that my baby get the TB jab when they're born but I was under the impression that everyone gets offered it in London especially in less privileged neighbourhoods.

the different pelvic types are well known and documented. as well as the prevalence based on race.

@Sugarintheplum - believe it or not both pregnancy were consultant-led (first pregnancy consultancy-led due to BMI level and second pregnancy was consultancy-led due what happened with my first labour, especially as DC1 was quite small when born).

I complained about the treatment I received during my first labour as I was sent home on my due date (despite having an infection, de-hydrated and unable to keep any fluids/food in) as wasn't dialated enough only to be told the next day (when I went back to the hospital) that I should never have been sent home and probably would have had DC1 on due date if I had been kept in.

I was monitored more with DC2 and everything was fine (baby measuring average birth weight) but when I went into labour the midwives were reluctant for me to come in as I didn't sound like I was too distressed. Given my previous experience I didn't want to take any chances so I went in regardless and I'm glad I did because I was kept in (examination confirmed baby had pooed in the womb), induced and had DC2 that evening.