References

Ashley R, Goodarzi B, Horn A A call for critical midwifery studies: confronting systemic injustice in sexual, reproductive, maternal, and newborn care. Birth. 2022; 49:(3)355-359 https://doi.org/10.1111/birt.12661

Bambra C, Riordan R, Ford J, Matthews F The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020; 74:(11)964-968 https://doi.org/10.1136/jech-2020-214401

Birthrights. Systemic racism, not broken bodies: an inquiry into racial injustice and human rights in UK maternity care. 2022. https//www.birthrights.org.uk/wp-content/uploads/2022/05/Birthrights-inquiry-systemic-racism_exec-summary_May-22-web.pdf (accessed 17 January 2024)

Braveman P, Dominguez TP, Burke W Explaining the Black-White disparity in preterm birth: a consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes. Front Reprod Health. 2021; https://doi.org/10.3389/frph.2021.684207

Brocklehurst P, Hardy P, Hollowell J Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011; 343 https://doi.org/10.1136/bmj.d7400

Caleyachetty R, Barber TM, Mohammed NI Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2021; 9:(7)419-426 https://doi.org/10.1016/S2213-8587(21)00088-7

Cohen SS, Alexander DD, Krebs NF Factors associated with breastfeeding initiation and continuation: a meta-analysis. J Pediatr. 2018; 203:190-196.e21 https://doi.org/10.1016/j.jpeds.2018.08.008

The search for the world's “missing” genomes. 2023. https//www.bbc.com/future/article/20230227-the-search-for-the-worlds-missing-genomes (accessed 23 August 2023)

Crenshaw KW Race, reform, and retrenchment: transformation and legitimation in antidiscrimination law. Harv Law Rev. 1988; 101:(7)1331-1387 https://doi.org/10.2307/1341398

Crenshaw K Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991; 43:(6)1241-1299 https://doi.org/10.2307/1229039

Birth in eight cultures. In: Davis-Floyd R, Cheyney M (eds). Long Grove, Illinois: Waveland Pr Inc; 2019

Dominguez TP Race, racism, and racial disparities in adverse birth outcomes. Clin Obstet Gynecol. 2008; 51:(2)360-370 https://doi.org/10.1097/GRF.0b013e31816f28de

Downe S, Byrom S Topalidou. Squaring the circle: why physiological labour and birth matter in a technological world. In: Downe S, Bryom S (eds). London: Pinter & Martin Ltd; 2019

Draper ES, Gallimore I, Smith L MBRRACE-UK perinatal mortality surveillance report uk perinatal deaths for births from January to December 2020.Oxford: National Perinatal Epidemiology Unit; 2022

Review of neonatal assessment and practice in Black, Asian and minority ethnic newborns: exploring the Apgar score, the detection of cyanosis, and jaundice. 2023. https//www.nhsrho.org/publications/review-of-neonatal-assessment-and-practice-in-black-asian-and-minority-ethnic-newborns-exploring-the-apgar-score-the-detection-of-cyanosis-and-jaundice/ (accessed 23 July 2023)

Feeley C, Thomson G, Downe S Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: findings from a feminist pragmatist study. PLoS One. 2020; 15:(11) https://doi.org/10.1371/journal.pone.0242508

Fernandez Turienzo C, Newburn M, Agyepong A Addressing inequities in maternal health among women living in communities of social disadvantage and ethnic diversity. BMC Public Health. 2021; 21:(1) https://doi.org/10.1186/s12889-021-10182-4

Gishen F, Lokugamage A Diversifying the medical curriculum. BMJ. 2019; 364 https://doi.org/10.1136/bmj.l300

INVISIBLE maternity experiences of Muslim women from racialised minority communities. 2022. https//www.mwnuk.co.uk/go_files/resources/maternity_report_120722.pdf (accessed 17 January 2024)

Gravlee CC, Sweet E Race, ethnicity, and racism in medical anthropology, 1977-2002. Med Anthropol Q. 2008; 22:(1)27-51 https://doi.org/10.1111/j.1548-1387.2008.00002.x

Greene NH, Pon FF, Kilpatrick SJ Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension. J Matern Fetal Neonatal Med. 2022; 35:(25)10103-10109 https://doi.org/10.1080/14767058.2022.2116977

Gutteridge K The birth of serenity. AIMS J. 2011; 23:(1)1-3

Gutteridge K From serenity to halcyon birth centre. Pract Midwife. 2013; 16:(1)33-36

Gutteridge K Midwife led care report. Women outside criteria.Bimringham, UK: Sandwell and West Birmingham Hospital NHS Trust; 2015

Hackett RA, Ronaldson A, Bhui K, Steptoe A, Jackson SE Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020; 20:(1) https://doi.org/10.1186/s12889-020-09792-1

Handa VL, Lockhart ME, Fielding JR Racial differences in pelvic anatomy by magnetic resonance imaging. Obstet Gynecol. 2008; 111:(4)914-920 https://doi.org/10.1097/AOG.0b013e318169ce03

Hernandez-Boussard T, Siddique SM, Bierman AS, Hightower M, Burstin H Promoting equity in clinical decision making: dismantling race-based medicine. Health Aff. 2023; 42:(10)1369-1373 https://doi.org/10.1377/hlthaff.2023.00545

All the women are White, all the Blacks are men, but some of us are brave - Black women's studies. In: Hull G, Bell-Scott P, Smith B (eds). Old Westbury, N.Y: The Feminist Press; 1982

Hutton EK, Reitsma A, Simioni J, Brunton G, Kaufman K Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: a systematic review and meta-analyses. eClinicalMedicine. 2019; 14:59-70 https://doi.org/10.1016/j.eclinm.2019.07.005

Jamali H, Castillo LT, Morgan CC Racial disparity in oxygen saturation measurements by pulse oximetry: evidence and implications. Ann Am Thorac Soc. 2022; 19:(12)1951-1964 https://doi.org/10.1513/AnnalsATS.202203-270CME

Kane MM, Bervell R, Zhang AY, Tsai J How should clinicians respond to race-based algorithms as sources of iatrogenic harm?. AMA J Ethics. 2022; 24:(8)E720-E728 https://doi.org/10.1001/amajethics.2022.720

Kinnunen TI, Richardsen KR, Sletner L Ethnic differences in body mass index trajectories from 18 years to postpartum in a population-based cohort of pregnant women in Norway. BMJ Open. 2019; 9:(2) https://doi.org/10.1136/bmjopen-2018-022640

Lamri A, Limbachia J, Schulze KM The genetic risk of gestational diabetes in South Asian women. eLife. 2022; 11 https://doi.org/10.7554/eLife.81498

Larner L, Hooks C Against the grain: midwives' experiences of facilitating home birth outside of guidelines. Br J Midwifery. 2020; 28:(6)370-376 https://doi.org/10.12968/bjom.2020.28.6.370

Li Y, Townend J, Rowe R Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2015; 122:(5)741-753 https://doi.org/10.1111/1471-0528.13283

MacLellan J, Collins S, Myatt M, Pope C, Knighton W, Rai T Black, Asian and minority ethnic women's experiences of maternity services in the UK: a qualitative evidence synthesis. J Adv Nurs. 2022; 78:(7)2175-2190 https://doi.org/10.1111/jan.15233

Mind the gap: a handbook of clinical signs in black and brown skin. 2020. https//wellcomecollection.org/works/ndx5vuhy (accessed 13 Aug 2023)

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. 2017. https//www.nice.org.uk/Guidance/CG190 (accessed 17 January 2024)

National Institute for Health and Care Excellence. Inducing labour. 2021. https//www.nice.org.uk/guidance/NG207/history (accessed 19 January 2024)

National Institute for Health and Care Excellence. Intrapartum care. 2023. https//www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth (accessed 19 January 2024)

Nazroo JY, Bhui KS, Rhodes J Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociol Health Illness. 2020; 42:(2)262-276 https://doi.org/10.1111/1467-9566.13001

NHS England. National maternity dashboard. 2024. http//tinyurl.com/2hmk9ycv (accessed 19 January 2024)

Niles PM, Vedam S, Witkoski Stimpfel A, Squires A Kairos care in a Chronos world: midwifery care as model of resistance and accountability in public health settings. Birth. 2021; 48:(4)480-492 https://doi.org/10.1111/birt.12565

The Black maternity experiences survey: a nationwide study of black women's experiences of maternity services in the United Kingdom. 2022. https//www.nhsbmenetwork.org.uk/wp-content/uploads/2022/05/TheBlackMaternityExperienceReport.pdf (accessed 17 January 2024)

Roberts D Fatal invention: how science, politics, and big business re-create race in the twenty-first century.New York: New Press/ORIM; 2011

Rocca-Ihenacho L, Yuill C, McCourt C Relationships and trust: two key pillars of a well-functioning freestanding midwifery unit. Birth. 2021; 48:(1)104-113 https://doi.org/10.1111/birt.12521

Jewish births rose three times higher than the British population. 2018. https//www.thejc.com/news/news/jewish-births-rose-three-times-higher-than-the-british-population-1.465802 (accessed 14 Aug 2023)

Rowe R, Li Y, Knight M, Brocklehurst P, Hollowell J Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2016; 123:(7)1123-1132 https://doi.org/10.1111/1471-0528.13546

Royal College of Obstetricians and Gynaecologists. Induction of labour at term in older mothers (Scientific Impact Paper No. 34). 2013. https//www.rcog.org.uk/guidance/browse-all-guidance/scientific-impact-papers/induction-of-labour-at-term-in-older-mothers-scientific-impact-paper-no-34/ (accessed 18 January 2024)

Scarf VL, Rossiter C, Vedam S Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis. Midwifery. 2018; 62:240-255 https://doi.org/10.1016/j.midw.2018.03.024

Proposals to induce labour earlier in pregnant ethnic minority women are ‘racist and discriminatory.’. 2021. https//www.independent.co.uk/news/nice-ethnic-pregnancies-early-labour-b1883225.html (accessed 14 Aug 2023)

Taber DJ, Gebregziabher M, Hunt KJ Twenty years of evolving trends in racial disparities for adult kidney transplant recipients. Kidney Int. 2016; 90:(4)878-887 https://doi.org/10.1016/j.kint.2016.06.029

Taylor JK Structural racism and maternal health among Black women. J Law Med Ethics. 2020; 48:(3)506-517 https://doi.org/10.1177/1073110520958875

Thakur N, Chandra J, Pemde H, Singh V Anemia in severe acute malnutrition. Nutrition. 2014; 30:(4)440-442 https://doi.org/10.1016/j.nut.2013.09.011

The King's Fund. The health of people from ethnic minority groups in England. 2023. https//www.kingsfund.org.uk/publications/health-people-ethnic-minority-groups-england (accessed 20 December 2023)

Standard, population & customised fetal size charts 5 – race ethnicity. 2019. https//ripe-tomato.org/2019/09/06/standard-population-customised-fetal-size-charts-5-race-ethnicity/ (accessed 13 August 2023)

Use of race in clinical diagnosis and decision making: overview and implications. 2021. https//www.kff.org/racial-equity-and-health-policy/issue-brief/use-of-race-in-clinical-diagnosis-and-decision-making-overview-and-implications/ (accessed 14 August 2023)

Warwick Clinical Trials Unit. Big baby, induction of labour for predicted macrosomia - The ‘Big Baby Trial’. 2023. https//warwick.ac.uk/fac/sci/med/research/ctu/trials/bigbaby (accessed 18 January 2024)

Ethnic and socio-economic inequalities in NHS maternity and perinatal care for women and their babies: assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales.London: Royal College of Obstetrics and Gynaecology; 2021

Weisband YL, Gallo MF, Klebanoff MA, Shoben AB, Norris AH Progression of care among women who use a midwife for prenatal care: who remains in midwife care?. Birth. 2018; 45:(1)28-36 https://doi.org/10.1111/birt.12308

Wheeler J, Davis D, Fry M, Brodie P, Homer CSE Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature. Women Birth. 2012; 25:(3)107-113 https://doi.org/10.1016/j.wombi.2011.08.003

Risk assessments and ethnicity in maternity care: looking through the wrong end of the telescope?

02 February 2024
Volume 32 · Issue 2

Abstract

Many Black and brown women are classified as ‘high risk’ and follow obstetric-led pathways. This may be the result of social determinants of health, or over pathologisation as a result of racial bias by healthcare providers and systems. There may be times when social determinants are mistaken for innate physiological differences, leading to iatrogenic harm. There is both over and underdiagnosis resulting from racial bias in midwifery care. Women with intermediate risk factors may benefit from midwifery-led care, especially Black and brown women. Community-based, relational, women-centred midwifery models of care can reduce the problems of pathologisation and redress some social inequalities.

Most research on midwife-led care and birthplace choice takes women already classified as ‘low risk’ as a starting point. Despite the well-documented benefits of midwife-led care (Brocklehurst et al, 2011; National Institute for Health and Care Excellence (NICE), 2017; Cohen et al, 2018; Scarf et al, 2018; Hutton et al, 2019), increasing numbers of women are classified as high risk, and consequently are put on an obstetric-led care pathway, especially in labour and birth. However, the mechanisms of the classification into low and high risk merit scrutiny, as data suggest this disproportionally affects Black and brown women and leads to higher rates of intervention in that population (Weisband et al, 2018; Webster and NMPA Project Team, 2021; Melamed et al, 2022). This article will explore the mechanisms for this, including the use of the white body as the ‘norm’, leading to both under- and over-diagnosis, social determinants of health, misuse of race-based risk algorithms, and falsely locating the cause of poorer outcomes in physiology rather than in social determinants.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month