50.50: Interview

Racism in UK maternal care: ‘Why aren’t we being listened to?’

Sandra Igwe on the trauma she and many other women of colour are left with after being disregarded during pregnancy

Anita Mureithi
22 June 2022, 11.39am
"What happens when motherhood isn't what you expected?"
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Illustration by openDemocracy using Canva. All rights reserved

“When my baby was born, I didn't have that joy. I looked at her, and I wanted to be happy… but all I could think about was what the heck just happened.”

What Sandra Igwe had just experienced was birth trauma. From the disrespect and dehumanisation throughout her pregnancy, to the lack of dignity and autonomy during childbirth, she could barely process what was going on.

As she recounts in her new book ‘My Black Motherhood: Mental Health, Stigma, Racism and the System’, similar experiences are all too common among Black women and women of colour.

“I always thought that motherhood looked beautiful,” she told me. “That [people] who had children… had this glow, and this reverence about them. I always respected mothers.”

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Growing up, Sandra watched how her Nigerian mother would go to the ends of the earth for her children. Through a child’s eyes, she never suspected that her mum might be struggling.

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Sandra Igwe: founder of The Motherhood Group

When she unexpectedly became pregnant with her first baby, her first “beautiful surprise”, Sandra thought she’d know how to handle the challenges of motherhood. “I was anxious but also thought I could do it, if my mum could do it with four girls on her own,” she told me.

Before becoming a mother, Sandra had lived her life carrying the burden handed to Black women and girls from birth: the need to always be ‘OK’. The thought that she’d struggle with postpartum depression never even crossed her mind.

“Something I’ve always said is that I’m strong. I’m resilient, I bounce back... But I now know that [attitude is] detrimental, not just to our mental health, but our physical health as well,” Sandra said.

She explained that this ‘strong, Black woman’ trope is something that has not only been perpetuated by healthcare services, but also by some in the Black community.

“I think we do have a part to play in how we glamorise or glorify strength. I don't think strength is something that we should have to carry on our shoulders.”

Disregarded and dehumanised

Pregnant for the first time, Sandra wanted to feel seen. She wanted to feel safe.

“[During antenatal appointments] I found my midwife quite cold… She never really looked me in my eyes.”

Sandra wondered why her midwife didn’t seem to like her. She tried small talk, she even tried jokes. Nothing seemed to work. She didn’t understand why she couldn’t get her midwife to crack even the smallest smile.

“Feeling anxious, I was just hoping that [the midwife] would reassure me that I'd be OK.”

She hoped that at the very least, caregivers would call her by her name.

A recent report by UK charity Birthrights, ‘Systemic Racism, not Broken Bodies’, shows that narratives of Black people as sub-human manifest in rudeness, disrespect and lack of empathy in maternal care.

Asian women are often viewed as “needing less support” with “a tendency to make a fuss about nothing”.

When Sandra was in labour, she went into hospital but was sent back home multiple times. “Being a first-time mum, I didn't know if that was normal… I was in excruciating pain, but was being told to go back home.

“On my fourth or fifth visit, I put my foot down… I shouted. I said I'm not going anywhere. You are going to see me.”

This gave me chills as I thought about my own mother, who at nine months pregnant went into hospital complaining of extreme pain. Midwives told her she was exaggerating, and to go home. They didn’t help her until she fell to the hospital floor on her hands and knees, in so much pain she couldn’t walk.

“Why is it that [people of colour] in the healthcare system have to be in agony and screaming at the top of their lungs to be taken seriously?” Sandra asked. I wonder the same thing.

We don't really have a say, and that’s quite sad

After being induced with no warning or explanation, Sandra saw how Black people are not given agency over their own bodies.

“We don't really have a say, and that’s quite sad… We should be allowed to be decision-makers in the way we give birth… That would have a positive impact on our mental health.”

When her second “beautiful surprise” came along, her experience confirmed everything she’d suspected about systemic racism in UK maternal care.

“I begged for an epidural because I knew I didn’t want to go through the pain I had the first time. I was told I couldn’t get it because there was a queue. In the end, I didn’t get anything.”

A US academic study found that healthcare providers are less likely to offer pain relief due to false beliefs like ‘Black people have thicker skin than white people’ and ‘Black people’s nerve endings aren’t as sensitive’.

In the UK, research unit MBRRACE-UK reported last year that Black women are four times more likely to die during childbirth, while a series of openDemocracy reports found that, at the height of the COVID-19 pandemic, maternal health outcomes worldwide were significantly worse for women of colour than for white women.

The mental toll of a broken system

Sandra went through numerous struggles typically faced by new mothers. But she also believes that racism and a poor standard of maternal care severely impacted her mental health.

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"I had no idea that… my mental health would be an uphill battle”

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Illustration by openDemocracy using Canva. All rights reserved

“I didn’t feel like I had control over [my mind]... This was extremely scary and frustrating.”

Postnatal depression and anxiety in mothers of colour is 13% higher than in white mothers. Black women and birth givers are less likely to seek treatment for postnatal mental illness. They are also less likely to be given follow-up treatment.

Feeling the weight of isolation, Sandra said she was never given counselling or a debriefing session after birth. “It was just like, OK, be on your way.”

The loneliness, the trauma of childbirth, the inadequate care, the pressure to be ‘strong’ and a lack of understanding about postnatal depression, left the young mother feeling helpless.

That’s why she’s written this book.

“The work that I do, it’s like revenge. Not to hurt anybody, but to get my power back.”

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