Higher risks, little support: Giving birth while Black and Asian in COVID-19 England

Women of colour are at higher risk of dying in childbirth and because of coronavirus. But the NHS has been slow to respond.

Tola Onanuga
11 August 2020, 7.12am
Risky times for pregnant Black and Asian women
MediaJet / CC BY-SA

Augelle Jamieson, from Bedford, was admitted to hospital in May during the coronavirus lockdown with agonising contractions. “I pray that no other woman ever is made to feel the way I was,” she told openDemocracy, describing how she was left in a room with no toilet or shower and “was fobbed off for hours until my baby’s head was out”.

“I was not offered any pain relief and I was naked and on the floor as it was so hot. I began vomiting,” Jamieson recalls. The student midwife who was assigned to her did not perform any vaginal checks, she adds, although the NHS states that these should be offered to women regularly to see how their labour is progressing.

She also says her request for a water birth was denied because the required room was already occupied by another woman. According to Jamieson, no alternative was offered, nor was she asked about the preferences in her birth plan that the NHS encourages all women to prepare to ensure that care “meets your individual needs”.

When Jamieson was moved to the hospital’s maternity ward after giving birth, her boyfriend, who had been present throughout her labour, was sent home and told he couldn’t visit until he came to pick her up. Jamieson says she begged staff to complete her paperwork so she could leave and was discharged the next day.

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“I thank God that my child is healthy,” she says, but describes giving birth during lockdown “emotionally distressing”. It’s an experience that resonates with that of several other women of colour in the UK who told openDemocracy that they did not feel supported despite facing increased risks during pregnancy and COVID-19.

“I pray that no other woman ever is made to feel the way I was… It’s been emotionally distressing”

Even before the pandemic, Black women in the UK were almost five times more likely to die in childbirth than white women. Black women have also been more than eight times more likely to be admitted to hospital with COVID-19 during pregnancy than white women, while Asian women are four times more likely to be hospitalised.

In May, a University of Oxford study said these hospitalisation rates warranted “urgent investigation”. Public Health England, meanwhile, has more broadly acknowledged the disproportionate COVID-19 death rate for people of colour.

At the end of June – more than three months after the pandemic was declared – NHS England said it was boosting support for pregnant women of colour. This includes increasing their Vitamin D uptake, ensuring ethnicity is recorded on NHS systems, along with other risk factors, and undertaking outreach in their communities.

“Although information was eventually provided by NHS England… it was slow in coming,” said Birte Harlev-Lam, executive director for professional leadership at the Royal College of Midwives’ (RCM). Her organisation also launched a campaign, Race Matters, in late June to support pregnant Black and Asian women.

Harlev-Lam said this campaign focuses on getting women “the practical information they need” while also “supporting research and championing positive change.” The RCM has also produced clinical guidance to help midwives identify and support ethnic minority women with high-risk factors, such as those who live in crowded conditions.

Despite this recognition of the increased risks they face, several Black and Asian who are pregnant, or who gave birth recently in England, told openDemocracy they had not received clear and timely information from health professionals about their higher chances of being hospitalised during the pandemic, nor how to protect themselves.

They described being pregnant during COVID-19 as a fraught and anxiety-ridden experience. Some also reported that measures imposed to prevent the spread of infection seemed inadequate or poorly enforced, putting them at further risk.

Jamieson said she did receive an apology from hospital officials over her treatment, but has heard nothing since they promised an investigation. NHS England did not respond to our questions about what it has done to protect pregnant ethnic minority women during the pandemic and ensure they have access to the information they need.

Higher risks, simple requests

“It was simple things that weren’t done, like having marked-off chairs or one-way systems,” said Fizza Qureshi, who is 36 weeks pregnant.

She says she raised these safety concerns with staff at an east London clinic she attended, and that they agreed to start enforcing social distancing measures. But this should have been the case across the NHS from the start, Qureshi insists.

“That would have given me more reassurance that they’ve really thought this through for the people that have to use these spaces,” she said, with other simple requests including “an initial conversation about risk factors... and [the availability] of telephone appointments and thinking through how I would get to the hospital.”

“Black women are eight times more likely to be admitted to hospital with COVID-19 during pregnancy than white women”

Another woman (who wanted to remain anonymous) described giving birth at Hillingdon Hospital in north-west London, days after its A&E unit closed in early July due to a COVID-19 outbreak. A midwife told her this “had not affected the maternity/labour ward because they operate in a separate building, but she could understand my concern.”

She said that her labour went well overall and the hospital’s staff and midwives “did everything they could to make it a positive experience. All staff in the postnatal ward wore masks, although one midwife took hers off to talk to me at one point, which I was not pleased about. But it's difficult to say something in that situation.”

Before giving birth, she recalls being anxious during antenatal appointments, which she had to attend alone under COVID-19 restrictions. Unlike in Scotland and Northern Ireland, these restrictions remain in place at many NHS Trusts in England despite the lifting of other lockdown measures and the reopening of pubs, restaurants and shops.

She says she had “planned an elective C-section this time after a traumatic birth with my first child,” and having to attend appointments alone, and then “relay information to my husband made me worry he wouldn't have as much information about the procedure, and therefore not be able to offer the full support I needed.”

'We’re not being cared for properly'

For some women, even getting in touch with a health professional during this crisis has been difficult. In March, Latisha Burke, from London, was six weeks pregnant at the time and recalls how she couldn’t get a doctor’s appointment. She says she “also struggled to get in contact with my midwife for about eight weeks.”

“I’ve now had one midwife appointment, which was over the phone, so they couldn’t check my blood pressure. I mentioned that I was feeling really anxious and was simply told ‘yes, but you’d feel even worse if you had coronavirus.’ So that was not great.”

Burke, who is a student, was already well aware of the increased risks facing Black women such as herself. As part of a university assignment, she created a podcast that explored the differing maternal health outcomes for women of colour.

“It does worry me that we’re not being cared for properly,” she says. “It’s great if I have a smooth birth, but it still makes me feel really rubbish to hear that another Black woman is having trouble… as basically I would just feel like I’m one of the lucky ones.”

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