African women
Five shifts, five labouring black African women, five cesarean sections. I've taken to carrying a scalpel around with me in case I see a poor pregnant black woman - might as well whip it out of her asap.
The problem, of course, is that all our "research knowledge" about normal physiological labour has been done on white women. We don't understand the way women from other races labour, and why it differs (and it does differ sometimes, in some women). We often get told at Uni - "many black African women have pevises shaped like x, as opposed to many Caucasian women, who have pelvises shaped like y", yet get no indication as to what these differences may actually mean in practice.
And when we get a black woman in the room in labour, we insist on treating her "non progressing" labour as we would a white woman's. Then, when she gets a section for failure to progress, we talk about obstructed labour and how, if she were "at home", her and her baby would have died. And by home, they mean Senegal or Ethiopia. Is it wrong that I bite my tongue and don't say that she is at home? That she lives right here?
We're in a sticky mess. Basically, the NHS is at pains to treat everyone the same - which means treating everyone based on the progress guidelines developed after observing white women. That is not equality. We can respect that many black women will labour differently - that's not racism. What is racism is the insidious notion creeping through my consultant unit that black women can't birth their babies. The smirk in handover when we hear a surname we think is African - the pointed comment of "I'll ring theatre, tell them to get ready!" and the snigger.
We are supposed to individualise care. To greet a black woman walking on to the ward and assuming they will labour in a certain way becasue they are black is as useless as assuming anythig in obstetrics. But, knowing that black women often make slow progress at the beginning of their labours, can we not make allowances for that before deeming them obstructed? Could we not integrate this into an overall clinical picture with confidence?
In the next post, I'll outlione what happened to the five African women I looked after on my last week on delivery suite. You can decide whether these women got sectioned for failure to be patient or failure to progress.
The problem, of course, is that all our "research knowledge" about normal physiological labour has been done on white women. We don't understand the way women from other races labour, and why it differs (and it does differ sometimes, in some women). We often get told at Uni - "many black African women have pevises shaped like x, as opposed to many Caucasian women, who have pelvises shaped like y", yet get no indication as to what these differences may actually mean in practice.
And when we get a black woman in the room in labour, we insist on treating her "non progressing" labour as we would a white woman's. Then, when she gets a section for failure to progress, we talk about obstructed labour and how, if she were "at home", her and her baby would have died. And by home, they mean Senegal or Ethiopia. Is it wrong that I bite my tongue and don't say that she is at home? That she lives right here?
We're in a sticky mess. Basically, the NHS is at pains to treat everyone the same - which means treating everyone based on the progress guidelines developed after observing white women. That is not equality. We can respect that many black women will labour differently - that's not racism. What is racism is the insidious notion creeping through my consultant unit that black women can't birth their babies. The smirk in handover when we hear a surname we think is African - the pointed comment of "I'll ring theatre, tell them to get ready!" and the snigger.
We are supposed to individualise care. To greet a black woman walking on to the ward and assuming they will labour in a certain way becasue they are black is as useless as assuming anythig in obstetrics. But, knowing that black women often make slow progress at the beginning of their labours, can we not make allowances for that before deeming them obstructed? Could we not integrate this into an overall clinical picture with confidence?
In the next post, I'll outlione what happened to the five African women I looked after on my last week on delivery suite. You can decide whether these women got sectioned for failure to be patient or failure to progress.
posted by Midwifette | 8:39 AM
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