When giving birth becomes a risk: a Black woman’s story

Following on from our previous blogs this Black History Month, which have explored the past, present and future of Black health in Scotland, this guest blog is a case story illustrating Dustin Husseini and Paula Terris-Pennycott's blog The injustices of social health determinants: how these are shaped and can be addressed. It shines a light on the lived experience of Black women and birthing people in the UK, who are disproportionately represented in statistics related to negative pregnancy and birthing outcomes. 

This blog was written by Melanie Allen-Clarke, a Paramedics student based in Cumbria University, who shares her birthing story in the context of her research on Black maternal health in the UK.

Content warning: death, racism, discrimination, childbirth and trauma.

Did you know that just being Black/Asian and pregnant in the UK can lead to an untimely death? Unfortunately, this is the sad reality for some Black and Asian women during pregnancy and after birth. NHS England’s Better Birth Report in 2016, identified that babies of Black and Asian descent were 50% more likely to die during the neonatal period. In addition, research Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (2024) found evidence to suggest that Black women are five times more likely to die in pregnancy, childbirth and the postnatal period compared to their white counterparts.

My personal experience as a Black mother

Drawing from my own experience of being a Black woman accessing maternal care, I feel fortunate to have lived to tell my story. In 2016 I fell pregnant with my third child. I was so happy, yet nervous, as I was aware of the statistics and systemic issues that  I could face because of the colour of my skin. During the final few weeks of pregnancy, I was raising concerns to my midwife/doctor and was not listened to. I was informed that an induction would be best suited as my baby was measuring quite big; however, in the back of my mind, I knew that there was a chance that I was not going to have a good experience. I remember writing letters to my children and family in the event my son and I did not make it. Tuesday came and the induction began. It started off well until the contractions intensified and I asked for stronger pain relief. I waited and waited, six hours passed – still no pain relief, no gas and air…nothing. It was not until the midwife handover later in the evening that someone finally identified that I had been ignored and provided  an anaesthetist for an epidural. The epidural was inserted but I still felt everything in its full intensity. I informed the midwife, to which she replied, “it is all in your head”, “you are strong – grin and bare it”. Hours of painful contractions later I was fully dilated, and my unborn son was showing signs of distress. The alarm was pressed, and a flood of doctors came in. I was encouraged to push, exhausted from the pain, I had nothing else to give. I was told forceps would be used to assist my delivery, and an incision was made. I screamed in agony and told them I could feel it, I immediately told them to stop but no one was listening. My partner shouted “stop!”.  I was rolled over by the anaesthetist and midwives to check the epidural, I could hear the whispers “it has kinked, she hasn’t received any of the medication”. Those were the last words I heard before I lost consciousness and missed the birth of my son. What was supposed to be one of the most amazing days of my life, turned into a day I would rather forget, and the trauma will live with me forever.

Why does this happen?

This year's BMJ article Why are Black women still more likely to die in childbirth? highlights several reasons why experiences like this may occur. These are: structural and systematic racism  underpinned by underlying biases of healthcare providers, lack of cultural competency, an underrepresentation of ethnic minority healthcare professionals and clinical factors. Studies have also highlighted that access to antenatal care and cultural influences also contribute to this. One of the leading themes in research on the experiences of Black birthing people, and other ethnic minority groups,  is  that parents often feel dismissed and disrespected and that communication is poor between clinician and patient. Underlying bias can create perceptions that Black people have a higher threshold for pain than other ethnic groups, and therefore, are not listened to in regard to their care. 

Call to action

Because of initiatives such as Five X More, a UK-based women’s health organisation focused on Black maternal health, and local organisations such as Amma Birth Companions in Glasgow, awareness of the systemic issues experienced by Black women is growing and more Black women and their families are coming forward and sharing their stories to challenge racial discriminatory behaviours. The UK Government Black Maternal Health report provides recommendations on how the needs of Black women and their maternal care can be addressed. Public Health needs to continue to collect, input, assess and publish the maternal and morbidity data. The Royal College of Midwives have urged The College of Obstetrics and Gynaecology to implement training to address cultural competence and unconscious bias. NHS trusts need to adhere to the clear expectations set out by the NHS Leadership Framework, by ensuring that NHS leaders tackle racism and provide inclusive care.

In conclusion the addressing and tackling of racial disparities is a role that everyone can play in order to produce positive outcomes for Black women. We can continue to raise awareness and challenge racial discrimination to protect our future mothers.