MBRRACE-UK report on ethnic inequalities prompts improved midwifery training

Last year, we highlighted disappointing findings from a 2020 report by MBRRACE-UK which looked at how women from minoritised ethnic groups are more likely to die or suffer injury in childbirth.

Two years on from the report’s publication, a new article reveals how two midwives at Yeovil Hospital took the MBRRACE-UK report so seriously that they have taken matters into their own hands.

In this blog, Fiona Dabell and Alicia Perry-Watts in our Medical Negligence team, look at the action these midwives have taken and what this means for future pregnancy and maternity care in Somerset and hopefully, the UK.

A new maternity training package

“It was heartening to read that these two midwives were determined to act on the MBRRACE-UK report’s shocking statistics. The report states that, between 2016 and 2018, for every 100,000 black women who gave birth, 34 died. In comparison, out of 100,000 Caucasian women, only eight died during childbirth in the same period.

Blog | New report reveals ethnic inequalities in the NHS

“After discussions during a night shift, the midwives decided to enter a competition to apply for research funding in which they highlighted that their midwifery training focused on white mothers and babies. In particular, they were concerned that training mannequins and dolls represented only white babies rather than black and ethnic minority babies. Their concerns were backed up by research highlighted by the British Journal of Midwifery which identified that outcomes for families from ethnic backgrounds might be improved with better training.

“The midwives won the competition and out of their research came a new training package which is being rolled out within maternity teams throughout Somerset. The training aims to improve clinical care and address ‘bias, stereotyping and microaggression in health’. It was clear from the article that other midwives had embraced the new training and were excited and proud to have done so.

“The two midwives recognised how important it is that midwives are exposed to training on the assessment of babies and mothers/parents from black, Asian and minoritised ethnic groups, as well as implicit bias training. Midwives also required training regarding the need to adapt assessment tools to ensure they reflect darker skin tones. It was evident that midwives benefited from this training, as pre-session surveys noted that many midwives were unaware of the factors influencing the care of women and babies from black, Asian and minority ethnic families. Feedback from midwives who have undertaken the training said it was a fantastic asset leading to a clearer understanding of biases and cultural stereotyping than they had previously.”

Significant gaps in training

“A recent article in the British Journal of Midwifery noted that less than one in three UK health trusts provide training on clinical signs of deterioration in women and children from minoritised ethnic groups or any cultural competency training.

“Local population needs were not considered by one in four organisations when determining training priorities. There were also significant gaps in training for clinical signs on darker skin in an emergency and regarding social complexities, communication and cultural awareness. A lot of training, textbooks and guidelines have pictures of exclusively white skin and there is a lack of representation of minoritised ethnic groups within the midwifery curriculum, including anatomical models and clinical diagnosis descriptions or images. It is common for there to be no or little resuscitation mannequins reflective of black women or babies and no training addressing cultural sensitivity, implicit bias or stereotyping.

“The APGAR scoring system, which is commonly used to assess whether babies need extra medical care after birth, is also criticised in various reports for its limited representation and lack of diversity. There are five elements to the APGAR Score:

• Appearance (skin colour)
• Pulse (heart rate)
• Grimace response (reflexes)
• Activity (muscle tone)
• Respiration (breathing rate and effort)

“The word ‘pink’ forms part of the ‘Appearance’ element of the assessment; something that may be misleading in babies with darker skin tones. Despite this, the APGAR scoring system remains a commonly used assessment tool to identify concerns for all babies.

“It was noted that this lack of representation can affect midwives’ and healthcare professionals’ ability to recognise, assess and care for women and babies from minoritised ethnic groups.”

“It is hard to believe that despite the ethnic mix in the UK, until just recently, healthcare students have only previously been taught how to care for Caucasian mothers and babies. The initiative taken by the two midwives at Yeovil Hospital will clearly accelerate improvements in maternity care from the perspective of minoritised ethnic groups.”

New Maternity Disparities Taskforce

“As a result of the MBRRACE report, the Maternity Disparities Taskforce was created in February 2022. Members meet every two months and focus on a range of action points, including improving personalised care and support plans, and developing targeted support for those from the most vulnerable groups.

“To support maternity staff and families further, the NHS is increasing the maternity workforce further with a £95 million recruitment drive to hire 1,200 more midwives and 100 obstetricians.”

Summary

“The third meeting of the Maternity Disparities Taskforce took place on Monday 18^th July 2022. At the meeting, the Muslim Women’s Network and human rights organisation, Birthrights, presented findings from their latest reports on Muslim women’s maternity experiences and human rights in UK maternity care.

“The report from the Muslim Women’s Network brought together the maternity experiences of over 1,000 Muslim women from minoritised ethnic groups and included examples of women describing being pressured into decisions, feeling as if they were being treated like a child and being denied pain relief during birth.

“Birthrights then presented their report on racial injustice and human rights in UK maternity care.

“The taskforce discussed their findings and considered key interventions. Using the expertise of its members, the taskforce is developing actions that address disparities for mothers and babies.

“It is encouraging to read that the results highlighted in the MBRRACE report have been taken so seriously and that, amongst other things, training is being targeted to deal with one of the root causes of this shameful disparity found in maternity care.”

Further information

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