By guest writer Kimberley Vassell.
I first found out I was pregnant in November last year. Whilst we weren’t exactly “trying”, I wasn’t using contraception so it was a surprise, but not completely unexplainable. Unprotected sex = pregnancy. Who’d have thought?
When the initial shock wore off, one of the first things that occurred to me was my maternity care. By now we all know the statistics that Black women are 4 times more likely to die in childbirth than their white counterparts. That statistic sucks when you’re not pregnant, but once you realise it could potentially happen to you, it’s a whole different ball game.
I’m fortunate enough to have a small pool of new moms around me (Black and otherwise) to discuss these issues with, and whilst everyone’s experience is undeniably different, there is one recurring theme in the conversations we have – you’re just left alone. This is certainly true of my experience and the experience of those closest to me. My cousin was told that she wouldn’t be having a home health visitor appointment – on the day, when she called because no one showed up – as “the midwife couldn’t make it”. This is after they told her they’d lost the results from her daughter’s heel prick test, and that they wouldn’t be doing another one. My best friend was induced twice, ignored when she said that she thought the first one hadn’t worked and ended up having an emergency C-section anyway. She was in hospital for over a week, and when she went home, her scar got infected. She called her midwife who refused to believe her and was told that if it was infected, then it was her fault for moving around and that no one could do anything about it. The pain got so bad that she went to A&E, who told her to go back to the hospital she gave birth at. Another friend was left with her legs in stirrups for hours because the doctor “forgot” to stitch her up after she tore. The list goes on, and everyone you ask has a story.
At 6 weeks, I called my GP to let them know I was pregnant. The doctor I spoke to (once I finally got through) didn’t seem particularly interested, asked if I felt sick and told me he’d refer me to a community midwife. Weeks and weeks went by without anyone contacting me, so I looked online and found that I could self-refer to my local hospital. Surprise, surprise, I received an appointment letter within days, so it’s clear my GP didn’t actually refer me at all. At that initial appointment, the community midwife was very nice but told me from the get go that she would not be my allocated midwife. I assumed this was just how things went and tried to get on with it.
The first and second trimesters were filled with all of the usual appointments for blood tests and ultrasounds. I realised quickly that I would never see the same person twice, so it’s been difficult to build a rapport with anyone. I’ve also found the staff to be quite detached – the ultrasound technicians were lovely but the community midwives treat you a bit like a form they have to get through rather than a person. I’ve been fortunate enough to have been quite healthy throughout this pregnancy with no significant problems, so the appointments have had an underlying tone of “Are you okay? Okay cool, see ya”. It’s also been really unclear as to who is who, so whenever I ask a question, it’s often received with a “Oh that’s not me/our department”, again with an undertone of annoyance that I don’t understand their system. I’ve gone round and round in circles until I’ve given up.
I think what has hurt the most is that the worst service I have received has actually been from Black members of staff. With this being my first pregnancy, I’ve been unsure of lots of things and when I needed simple reassurance, it has been Black nurses and midwives that have often made me feel the most incompetent and foolish. It’s almost as if they feel they can be extra rude and short tempered with me because they assume I’m going to be that way with them. It’s a double-edged sword of racial stereotyping and it’s frustrating, especially because of all the people you’d hope would be on your side, it’s women who look and sound like your mothers and aunties. Considering all the work that grassroots organisation Five X More have done to combat the disparities in maternal care, it’s an extra sting that is hard to shake.
As a teacher, I completely understand the impact of under-funding and staff shortages – we’re all just doing the best we can. But I can totally see why Black women are more likely to die or suffer complications in childbirth and honestly, I don’t think it’s an issue of out and out racism. When I’ve spoken to those around me, there is a shared sense that it isn’t that staff simply don’t care, but that they are overworked and understaffed, which makes them tired and impatient. If there is an imaginary hierarchy, then you come bottom of their priority list. It’s a combination of lack of resources and a racially biased assumption that you can leave a Black woman to deal with whatever issue she has alone for longer, because we’ll be fine. You almost feel like you’re an inconvenience to them, because other women are more important.
I live in Birmingham, in a large inner-city area, which many people may class as deprived. We have a large Black population and my local hospital is probably serving thousands of people with complex health issues – I get it. But what I find sad and frightening is knowing that I am very likely to have a poor, even traumatic birth experience. I’m currently 31 weeks and my clinic has “forgotten” to make my last two appointments – I haven’t been seen since I was 25 weeks, despite calling and calling to voice my concerns. I don’t have an allocated midwife and likely won’t, which is certainly not the pregnancy experience I’d imagined. My mental health has been fraught and delicate at times and I’ve felt unsupported, isolated and unprepared. Any maybe that’s not their job, but when you’re hyper-aware of the disparities among Black mental health care and that Black children are over-represented in the care system, it doesn’t fill you with confidence to speak up about your struggles. Besides, who is there to speak to anyway?
I’ve had to pay for antenatal classes because the hospital doesn’t provide them. My biggest concern is that, when the day comes, my needs and feelings will be ignored and I could suffer completely unnecessary complications. That I’ll be forced into having an induction or C-section because they just want me out of the hospital, that I’ll have a longer recovery time and that I won’t be seen by a health visitor afterwards because they don’t have the staff, worries that my friends and I share. What’s worse is that if I or my partner express my concerns, I’m seen as aggressive or demanding, and if I don’t, me or my baby could die. This isn’t me being dramatic, this literally happens to women every year. I feel like I can’t win.
I have a huge urge to take control into my own hands, so I’m preparing as much as I can on my own. I’ve managed to receive a free hypnobirthing course from Five X More, which has been a Godsend, and I’m leaning on friends and family as much as possible for all of my questions, something I’m so grateful for. Because truthfully, there’s no one else to ask.
One department which has been an exception to the rule and provided excellent care is the sickle cell and thalassemia department. I’m a sickle cell carrier, so I’ve always known that if I were to get pregnant that this could be an issue. Thankfully, my partner isn’t a carrier so there’s no chance of the baby having the full sickle cell disease, but the clinic flagged this straight away and we were forwarded for testing within days. They also took the time to call me and explain everything, from what could happen if my partner tested positive to what the outcomes could be for the baby. I was also called again to make sure that I’d gotten the results and to ask if I had any questions. They were fantastic, and I’d urge anyone with Black or Asian heritage to find out if they or their partners are sickle cell carriers unknowingly, and to have a very frank discussion about their plans for children should this be the case.
For now, I’m trying not to worry. I’m staying as active as possible, eating as well as I can and trying to rest and prepare. I’ve taken maternity leave slightly earlier than normal at work so I can focus on getting my body ready. In an ideal scenario I’d pay for private health care or have this baby at home, but those aren’t options right now so I’m just trying to do the best I can. When it comes down to it, I want to know I’ve done everything in my power to get this baby earth-side as quickly, safely and problem-free as possible. Because truthfully, I’m not confident that the NHS will do the same.