Category Archives: Policy

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.

Breastfeeding, Tyranny and the RCM’s new Breastfeeding Statement

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“End of breastfeeding tyranny!” scream the headlines. “Midwives instructed to stop shaming mothers!” they tell us, as though this is a new revelation that they’ve discovered, as though anyone, ever, telling women what to do, is something that any reasonable person should support.

Where has all this hyperbole come from?

The RCM has released a new breastfeeding position statement. It says, “Breastfeeding, more than any other health behaviour, has a broad-spectrum and long-lasting impact on public health.” This phrase itself should be repeated (and repeated and repeated) at every opportunity by every person campaigning to improve support for breastfeeding. Why is it that this isn’t the phrase that was picked up by the media and splashed across its headlines? Instead, they decided to focus on the phrase, “[if] a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.” It seems that this message, above all others, has been the one chosen to splash across the front covers. It’s a desperately important message, and one that I wholeheartedly support. It is at the root and centre of the training of breastfeeding counsellors, who are required to offer non-judgemental, woman centred support including to women who don’t want to, or who want to stop, breastfeeding. It breaks my heart to read the awful stories that are abounding today from women who have had midwives who are more worried about their BFI status and breastfeeding stats than the people in front of them and I completely agree that any undue pressure must stop, just as women should not be pressured to NOT breastfeed.

But here’s the problem: The media don’t care about breastfeeding support, nor do they give a hoot about the women and babies who are mixed up in the middle of this. All they want to do is to create enormous straw men. In fact, they aim to create a veritable wicker man, with supportive non-judgemental care, and the consequential negative impacts on women and their babies, being the burning sacrifice, all with the aim of kowtowing to the god of the fruit of newspaper sales.

The RCM’s report is packed with hugely valuable and important statements. Let’s just take a look at a few of them:

  • Clinicians should make every effort to support skin to skin for an hour after birth
  • Maternity units should be appropriately staffed, and sufficient investment made In postnatal care to enable each woman to get the support and advice she needs to make informed choices about feeding her baby.
  • UK-wide Infant Feeding surveys (which were discontinued in 2015) should be reinstated

These are just a few examples of some of the really important details that could have been covered by the media, but which have been ignored in favour of the more colourful, but morally vacuous focus on what they are calling “the breastfeeding tyranny”. A reasonable discussion about the removal of qualified support for women where breastfeeding groups have been decommissioned, or a campaign to upskill midwives who are expected to support women to breastfeed with a few days of training (compared to the two year breastfeeding counsellor course), or perhaps an article on why women are still having their babies taken from their bodies and denied skin to skin – these would all be hugely valuable topics for the media to cover. These would all be game changers for mothers and babies.

Let’s not be under any illusions. The media used the component of the report that it did and ignored the rest because it sells newspapers, and it increases the rhetoric that causes even more stress and distress around infant feeding. This was not intended to support women, nor to help those who have had the horrific experiences that we see in the comments section today, and who we must continue to listen to, hear and demand change for,  but to sell newspapers. Nothing more.