MBRRACE: Why More BME women and babies die. A BME woman responds.

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Guest Blog by Beth (an AIMS member)

I remember questioning a few midwife friends about how Black and Minority Ethnic (BME) women are treated in the maternity system. The consensus is we are treated differently but not in a good way. I wish I had known earlier. Outcomes and experiences are worse even when you take away the obvious social economic factors.

BME women like me are more subjected to interventions because of arbitrary criteria such as BMI, our baby’s growth is measured against a population which is not similar to ours, and I noticed that the gestational diabetes criteria negatively affects a lot of Asian women. Our options of where and and how to birth are therefore significantly, and I’d say unfairly, limited. The constant narrative that we’re not optimal for birth because of our body size, this and that. All of my friends who are of oriental descend have been treated horribly when giving birth. None of us fall into the stereotypical vulnerable groups (non English speaking, low income, uneducated, domestic violence, substance abuse etc). None of us are over 40 years old, either.

The truth remains that the NHS maternity risk assessment is racist, non evidence based and arbitrary. The midwives and obstetric staff feel that they have a right to carry out protocols against us because they’re written in hospital guidelines. We’re considered not just as a sub class of people but our bodies are less superior and non optimal for birth because we’re not white, not a certain body size and not significant enough in number. It’s the high intervention rates, abusive practices and attitudes that make accessing maternity services more dangerous for BME women. I say the lack of acknowledgement of the issue means it’s not addressed.

When someone doesn’t think BME women deserve human rights (life) and doesn’t really care about them, they are less likely to take their concerns seriously, less likely to take care with their bodies, nor, I suppose, do they want to save them in an emergency. The NHS is unlikely to acknowledge that or the fact that higher intervention rates can cause higher mortality rates because they can cause complications and complexities.

If more interventions really mean better safety, over 40 years olds and BMEs are subjected to more interventions so you’d expect mortality to come down and not go up significantly. Something’s not adding up. I don’t think the real issue is age nor race nor ethnicity. We’re very much designed to survive whatever the colour of our skin.

I think the problem is the poor attitude towards women – the power imbalance in the care model exacerbated by institutional racism. I don’t think it’s just the obvious issue with differences in colours of skin. There’s tribalism between different groups of similar skin colour. Having institutional protocols mean that poor treatments of particular groups go undetected. All these factors are what makes pregnancies and births more dangerous for many BME women, all else being equal.

Britain, our home, is multicultural. Now is the time for our healthcare system to move on with the times and provide a maternity care model that understands and responds to women’s needs with fair and evidence based assessments. Treat every woman with respect and care. Give us all continuity of carer (in pregnancy, birth and postnatal recovery), a relationship-based model, which has been proven to improve outcome, experience and importantly reduce errors (i.e. reduce mortality). The disproportionately high maternal mortality rates for BME women have been highlighted in the latest MBRRACE report. The structural inequality and poor attitudes in the healthcare system needs to be addressed urgently. (https://www.npeu.ox.ac.uk/mbrrace-uk/reports).

The quality of healthcare we get and our chance at survival shouldn’t be determined by the colour of our skin. We are the same with the same human needs underneath it all. It’s time for us to all stand together to demand the NHS to prioritise maternity services and stop denying us care, damaging our health (harming women and babies) when we need care the most. We have worked hard to pay for our health system. It is not right for our needs to go unmet. The NHS must respond to women’s healthcare needs for our country to thrive.

Note from admin: If you would like to support or join in campaigns for quality and equality in maternity services, please contact AIMS at www.aims.org.uk.

Proposal to bleed 1/5-1/3 of a baby’s blood within 4-24 hours of birth in order to reduce neonatal jaundice

Guest blog by Emma Ashworth

A randomised controlled trial has been proposed by Andrew Weeks and Susan Bewley which aims to reduce neonatal jaundice in newborn babies.
The key ongoing argument from obstetricians, neonatologists and paediatricians who continue to cut babies’ cords immediately after birth (known as immediate cord clamping or ICC) is that babies who have delayed (about a minute) or optimal cord clamping (wait for white) have higher rates of jaundice compared to their ICC peers. Despite the fact that we are well aware of some of the dangers of ICC, which include neonatal anaemia and cerebral palsy, plus reduced fine motor skills and social functioning in 4 year olds, Weeks and Bewley argue that, “[ICC] remains entrenched, undocumented and unmonitored in the UK, which had one of the highest rates in Europe.”

The authors note that the additional cord blood available with ICC leads to a higher level of stem cells if cord blood is being collected for commercial storage, thereby giving a strong financial incentive to cut the cord immediately. They therefore suggest that rather than berating what they call “vampire capitalism”, they instead propose a randomised controlled trial which they refer to as the “PrEmature cord clamping vs. Routine umbilical vein VEnesection blood volume ReducTion study”. Take your time.

Essentially, the study suggest comparing ICC with OCC followed by an umbilical vein catheter inserted which will, over about an hour, drain off about 19ml/kg of the baby’s blood. They note that this might cause some distress to the parents, which they suggest might be offset by taking the baby away and doing the procedure in another room, playing reassuring music or encouraging the parents to watch a video. They propose that perhaps, over time, the procedure would become more acceptable and even be a part of the birth ritual “whereby the father is encouraged to participate in the ‘releasing of tension’ through the draining of blood.”

I do hope that there are no Born Stroppy readers who are not actually horrified by this proposed research project, and that you have all recognised that this is what they call an “Implausible, but not impossible” satirical suggestion. Bewley and Weeks finish their proposal with, “Those who question the satirised ethics of this RCT should also examine the ethics of inaction while premature cord clamping continues.” We agree, and we ask that everyone who reads this makes the next step of sending it to their local Trust’s neonatal, obstetric and paediatric team, MSLC/MVP and the maternity CCGs. The sooner that the dangerous practice of bleeding babies at birth through immediate cord clamping is stopped, the better.