Today Five X More launched their report into the findings of the Black Maternity Experience Survey, which they carried out.

I read the report of the survey results with a sinking heart. As a solicitor who has acted for many black women with maternity claims, I hoped that the survey might reveal that the experiences I hear about are not as common as I feared and suggest that progress is being made with black maternity safety. However, the report found that the UK’s black women are still experiencing maternity discrimination and mixed levels of care.

Inequalities in maternal death rates between black women and white women in the UK have been documented for many years thorough the MBRRACE-UK (Mothers and Babies; Reducing Risk though Audits and Confidential Enquires) reports.

Despite the striking disparity between black and white women’s maternal experience, the reasons for the differences between outcomes remain unclear. The aim of Five X More’s survey was to better understand black women’s experiences of UK maternity care.

The Black Maternity Experience Survey gathered data from 1,340 women around the UK who either identified as black or of black mixed heritage and had accessed NHS maternity services whilst pregnant between 2016 and 2021.

The survey reveals both positive and negative experiences but sadly the negative experiences far outweigh those in which women were happy with the care that they received.

Key survey findings

Antenatal care

• Engagement with antenatal care was high with 96 per cent engaging with maternity services in the first trimester of pregnancy and 95 per cent of women engaging fully with midwifery, doctor and sonography appointments.
• However, for women who experienced miscarriage or pregnancy loss, 61 per cent report that they were not offered any additional support to deal with the outcome of the pregnancy.

Labour and birth

• Just over a third (36 per cent) of respondents reported feeling dissatisfied with how concerns were addressed during labour.
• 43 per cent reported their pain relief options were not explained to them and 52 per cent of women who did not receive their choice of pain relief said there was no explanation as to why it was not given to them.

Postnatal care

• A third of respondents (31 per cent) were concerned about the healthcare they received from their midwife during the birth recovery period.
• However, 69 per cent of respondents said they were somewhat or very satisfied with the postnatal health check-up performed by the health visitor.

While 78 per cent with health concerns after birth said they raised their concerns with a Health Care Professional, 36 per cent of respondents said that they were not confident to ask for help on the postnatal ward.

When looking at negative experiences revealed by the survey Five X More’s report found that these fit broadly into three categories:

 1. Attitudes (e.g., using offensive and racially discriminatory language; being dismissive of concerns),

The attitude most frequently described in the report was one of dismissiveness, with consistent reporting by many women of genuine concerns being ignored. Many of the women who responded to the survey felt that dismissal of their concerns led to emergency situations. By way of example one black woman commented:

“… [my baby] she was struggling to breathe after birth. I was told that it was a normal thing for newborns. No checks were done to put my mind at ease. After about 20 mins, my baby stopped breathing. Efforts were made to resuscitate her, but she later died in NICU.”

Other black women reported discriminatory comments: 

“Surnames were described as being “difficult to pronounce” , and making fun of how family members spoke: one woman recounted how her homebirth had been spoiled by the midwife mocking her partner’s accent as he phoned family members with the news of their new baby.” 

2. Knowledge (e.g., poor understanding about the anatomy and physiology of black women; poor understanding of the clinical presentation of conditions in babies of black women) 

The survey highlighted how there was a lack of knowledge and understanding by some healthcare professionals about the anatomy and physiology of black and black mixed heritage women and how this impacted pregnancy. Some of the comments in the survey include:​​​​​​​ 

“One midwife when doing the sweep said that the reason for dilation taking so long for me was “probably due to an African pelvis” even though I was on pain relief I was mortified that she actually believed there was such a thing as an African pelvis.”.​​​​​​​ 

“I was fobbed off by the phlebotomist who refused to take my ethnicity form which my midwife had given me as she said they didn't need it - as such, I was noted as white and my sickle cell test was not done.”

3. Assumptions (e.g., racially based assumptions about the pain tolerance, education level, and relationship status of black women). 

A prominent feature of black and black mixed women’s experiences was a reluctance or refusal to provide adequate, if any, pain relief. This behaviour was evident during labour in particular, but also postnatally, with women often describing begging for assistance with pain management but being frequently told that it was “too late” or that they looked like they were “coping”. Some examples given by those who responded to the survey were:

“I literally begged for an epidural, I stated repeatedly something was wrong, to which the midwife said I was fine, the obstetrician examined me and stated the baby was stuck.”

“There was a sense that the midwives felt I could handle the pain. I was left alone to give birth to my baby in the toilet. She fell into the loo on my last push. The midwives didn’t check on me for hours.”

The report also found that assumptions were made about black women’s immigration status and education levels. For example, when asking about breakfast on the postnatal ward, a black woman was told, “this is not how we do things over here”, despite her being from the UK.

A black mixed heritage woman recounted her experience of attitudes towards her changing once they learnt that she was a lawyer.

 “I’d turn up in a tracksuit and be spoken to in a certain (dismissive) way until they learnt I was a lawyer…and they would be more respectful overall in my experience.”.

The report has made the following recommendations which I hope will be implemented by the NHS to ensure that racism and racial bias can be eradicated from black women’s experiences of what is supposed to be a joyful event and no longer cause black women and their babies to suffer such high levels of injury and death.

Recommendations

1. An annual maternity survey targeted specifically at black women
2. Increased knowledge on identifying and diagnosing conditions that are specific to and disproportionately affect black women
3. Improve the quality of ethnic coding in health records
4. More community-based approaches must be used to improve maternal outcomes
5. An improved system for women to submit their feedback and/ or complaints specifically for maternity
6. Ensure that individuals involved in training health care professionals are aware and have an appreciation of the disparities in maternity outcomes.

Reading this report was very difficult and upsetting as the data from the survey highlights how discriminatory experiences continue to prevail for black women. Sadly, the findings of the Five X More survey reveal that the negative experiences many black women have are not just “one offs” but are systemic features of UK maternity care.

Birthrights (a charity which champions respectful care during pregnancy and childbirth by protecting human rights) has also released their report “systemic racism, not broken bodies” this week which found similar themes of black and Asian women being ignored and disbelieved, experiencing racism by caregivers, and suffering dehumanisation behaviour which impacted their choice and safety in pregnancy and labour.

Sadly, the black women I represent in clinical negligence claims often recount the same feeling of being dismissed and their concerns not being taken seriously enough. They are often left with the uncomfortable suspicion that discrimination contributed to the harm they and their babies have experienced, which only adds to the trauma they already feel. This is unacceptable.

I hope that these reports which provide first-hand evidence of black women’s maternity experiences will be a ‘call to action’ and that their recommendations will be actioned swiftly so that maternity care is made as safe as possible for all women irrespective of race.