Less likely to get pain relief and at greater risk of dying during labour
BLACK women are five times more likely to die during or shortly after pregnancy than white women. For mixed race women, the risk is three times that faced by white women; for Asian women, the risk is double that of white women, according to research published last year by the University of Oxford.
This is the alarming picture facing black, Asian or minority ethnic (BAME) women giving birth in the UK today. While for the vast majority of women, childbirth is a safe experience, for a very small number it is not.
Between 2015 and 2017, 209 women in the UK died during pregnancy or within six weeks of birth — and women from BAME backgrounds are disproportionately represented in that tragic number.
The rate of stillbirths is also higher among BAME mothers: there are 3.74 stillbirths per 1,000 births in the UK each year, but for Asian women the rate is 5.7 and for black women it’s 7.46.
What lies behind these troubling statistics — and personal tragedies — is complex, say experts, taking in a range of pre-existing health conditions as well as socioeconomic factors.
However, this is ‘certainly not the full story,’ says Dr Christine Ekechi, a consultant obstetrician and gynaecologist at Imperial College Healthcare NHS Trust.
‘There are women from BAME backgrounds who do not share the characteristics that we would commonly ascribe to a greater risk of mortality,’ she says.
‘In other words, they were born in the UK and English is their first language, they’re not overweight and have no pre-existing conditions. So why are these women still at greater risk?’ She points to prejudice within the healthcare system. Dr Ekechi, who is spokesperson for racial equality at the
Royal College of Obstetricians and Gynaecologists, says it is essential the medical profession doesn’t shy away from addressing this.
She suggests the problem is partly structural — such as medical students being taught to spot a lack of oxygen in the mother or the baby by looking for cyanosis, or blue skin. In darker skin tones, this might not be obvious, says Dr Ekechi, so attention must be paid to other symptoms, such as heart rate changes.
But she says prejudice is also manifested at the personal level. A 2016 U.S. study in the Proceedings of The National Academy of Sciences, found that as many as 40 per cent of U.S. medical trainees hold beliefs such as black people are not as sensitive to pain. The study revealed trainees with such opinions were less likely to treat pain in black people appropriately. ‘Looking at data from the U.S. and the UK, black women are less likely to be offered pain relief during labour,’ says Dr Ekechi. Lack of adequate pain relief during labour is a common complaint, with an inquiry this year finding that many women are still denied epidurals, against official guidelines. But a study in 2013 by the University of Oxford of nearly 25,000 women found that BAME women were less likely to receive not just epidurals but all types of pain relief.
Sharmika Dockery says her increasing pain was ignored for two weeks following the birth of her son, Riley, by an emergency caesarean.
Sent home after two days, Sharmika, 25, a full-time mother from South London says: ‘I was in agony. My scar hurt horribly, and at night I was sweating right through the sheets. I had to change up to five times a night.’
A midwife said ‘it was probably because I was breastfeeding’, while her GP, seeing her struggle to sit properly, dismissed her pain as things just being a bit ‘stuck together’. Eleven days
after Riley’s birth, another midwife noted Sharmika’s high temperature and blood pressure and sent her to A&E.
By now passing blood clots and in agony, she was simply given antibiotics and sent home.
Later that evening, her temperature rocketed and she was taken to hospital in an ambulance. The next day Sharmika insisted on further investigations — which revealed part of the placenta had been left behind, causing an infection.
She needed surgery, but on her third day in hospital, this was delayed. Sharmika, then just 17, was told: ‘There’s no rush, your head isn’t falling off!’ Yet, she recalls: ‘I was in so much agony, I was scared I’d die.’
She had the surgery later that day only after a nurse insisted on bringing the surgeon to see her. ‘I feel like that nurse saved my life.’
But in the seven years since, Sharmika has battled crippling pain and has needed repeated surgery.
She’s also suffered permanent nerve damage in her pelvis and legs.
This has affected her bond with Riley. ‘I spent the first years of his life in and out of hospital,’ says Sharmika, who has set up a support group, Beyond Strength, for parents managing longterm health issues. Although still young, she fears she won’t be able to give Riley a sibling. ‘I’m petrified, to be honest.’
Sandra Igwe’s experience followed a similar pattern. During her first labour, when she was eventually given the epidural she’d ‘begged’ for, it failed. She also suffered a third-degree tear (extending to the back passage) and struggled to walk for weeks. Sandra, 30, who lives with her husband and daughters, aged four and two, in South London, says the experience made her question having a second child. And the second time, her worst fears were realised. ‘I didn’t get an epidural at all, even though it was in my birth plan and I was begging them for it.’
Sandra, who’s since set up The Motherhood Group, a support network for black mothers, believes ‘every black woman should have an advocate in hospital — or else risk not just being disregarded but dying’.
Dr Ekechi adds: ‘Racism isn’t just shouting racial epithets on the streets. It’s about how we create hierarchies in our heads and in our society about who is important and who isn’t.’