Ask any Black woman – we get second-class NHS treatment

It’s not just on maternity wards where Black women are denied pain relief or more likely to suffer poorer outcomes – the entire health service works against us, says Ava Vidal

When I gave birth for the first time, my concerns were dismissed by my medical care providers. I put it down to my age, as I was only 18 at the time, rather than my skin colour.

But as a new survey finds that a quarter of Black women experience discrimination in the NHS – how, in particular, on maternity wards, Black mothers are denied the pain relief, such as epidurals, routinely given to our white counterparts, and that we are up to four times more likely to die in childbirth – I’m not so sure.

I’d wager that every Black mother I know has her own little NHS horror story. I remember a midwife telling me that I was putting on too much weight, and asking sarcastically if I had ever heard of salad. I already felt bad about myself, as I’d developed cankles for the first time.

When I was later diagnosed with edema, which led to pre-eclampsia, my labour had to be induced several days early. Looking back, I didn’t receive a lot of pain relief, even though I was in so much pain, I kicked the footboard at the bottom of the bed clean off.

I was so traumatised by the experience that I never had another natural childbirth again, both other times opting for an elective C-section. The second time I gave birth, five years later, I had planned to have a general anaesthetic. I didn’t want to be awake for any of it.

Two hours before the operation, I had a visit from a member of the medical team who asked if I minded having an epidural instead, because the anaesthetist wanted to go home, and it was only me keeping him there. I felt horrible refusing, and spent the final two hours of my pregnancy scared that they would “accidentally” give me too much medication, and I would die on the operating table.

I still can’t believe the maternity unit had the audacity to put that amount of pressure on me – but it seems I’m not alone.

According to a survey of more than 1,000 Black and mixed-race women by Five X More – a grassroots women's health organisation which takes its name from the statistic that Black women are five times more likely to die during childbirth that their white counterparts – half of all Black women did not receive pain relief when they requested it.

It all seems to stem from a misplaced – and let’s call it what it is: racist – mindset among midwives and doctors that “strong Black women” simply don’t need as much help as other patients. I mean, our ancestors were happy pushing out their progeny without modern medicine – they gave birth on their own, while standing up, didn’t they? Wouldn’t we prefer to just get on with it without gas and air?

A friend of mine, who is now a senior cardiologist, told me: “At med school in the 90s, we were taught that Black women had a higher pain threshold during labour, so they didn’t usually ask for pain relief.”

There have long been serious concerns in the Black community about the treatment Black women receive during maternal health care. It was the subject of a Dispatches documentary in 2021, presented by Rochelle Hulme.

The myth of the “strong black woman” is also partly a legacy of slavery. Medical historians point a finger at Dr J Marion Sims, the 19th-century physician who became known as the “father of modern gynecology”, having invented the vaginal speculum – but whose pioneering surgical techniques were practiced on enslaved women. His statue in Central Park was pulled down in 2018.

Even more shocking to me is that medical racism within the NHS doesn’t just exist in maternity care, I believe it’s pervasive across the entire service. I know a woman who has been battling the NHS – and been belittled by it – ever since she was a girl, when she was diagnosed with a chronic autoimmune disease that causes muscle weakness and tiredness.

“I used to fall asleep in lessons, but was told by teachers there was nothing wrong with me, that I was attention-seeking, that I was a liar and fake. At 11, I was diagnosed with Myasthenia gravis, symptoms for which I had shown since the age of 4.”

Today, she needs regular plasma transfusions, so spends a lot of time receiving medical care. “I’ve had so many bad experiences, panic attacks thinking I was going to die,” she tells me, “and yet white people with the same condition tell me they have not suffered.”

Once, while having antibiotics administered intravenously, she was left unable to speak – yet her nurses ignored her obvious distress. “All I could do was point to the cannula and whisper ‘Out…’. When two policemen walked past, they pointed and laughed at me, acting as though I was a mental health patient. The nurses joined in laughing and joking.”

I know that the plural of anecdote isn’t data, but Black people do have a rougher ride at the hands of our medical profession. Certainly, health campaigns for conditions that disproportionately affect the Black community, such as sickle cell anaemia and prostate cancer, don’t seem to get the same profile as others.

When it comes to ensuring the NHS is more attuned to the needs of Black patients, I won’t hold my breath – because if I did, they might just leave me to suffocate.