Members to receive a report on black maternal healthcare and mortality, including details of what the local maternity and neonatal system is doing to address health inequalities and poor outcomes for women of a black and minority ethnic background.
The Committee received a report on black maternal healthcare and mortality, including details of what the local maternity and neonatal system was doing to address health inequalities and poor outcomes for women of a black or minority ethnic background.
Elaine Broughton, Head of Midwifery introduced the report and drew attention to the following points:
This report followed on from the work of MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) which continued to highlight multiple and complex problems that affect women who die in pregnancy, these could be a combination of social, physical and mental or just one of these factors alone. The Covid pandemic had also highlighted even more disparity.
During the Covid pandemic MBRRACE published a rapid report following a review over a 3 month period from 1st March 2020 to 31st May 2020 which included several key messages. During that period 10 women died, the majority being from black/ethnic minority backgrounds and the report went on to identify existing guidance that needed improvement and recommendations that needed implementation.
Following that report the NHS had developed a long term plan and recommendations to be implemented as part of their Equity and Equality: Guidance for Local Maternity Systems and on the back of this a piece of work was being done by LLR health colleagues around equality analysis. That would be used to inform an action plan and would be reported to the committee in due course.
Members discussed the report which included the following comments:
The in depth summary was welcomed and it was acknowledged this was a very difficult subject.
In terms of lessons learnt, all deaths were investigated by an external H&S branch set up by the government, that involved extensive investigation and a comprehensive report of findings, and this had been in place locally for over 2 years so there was confidence that the service was addressing lessons to be learnt.
It was noted that one of the issues raised concerned black and ethnic minority women’s voices not being heard and it was asked how the service were taking that forward. Floretta Cox, Midwifery Matron advised that they were developing a dashboard with key performance indicators to look at issues such as this. There was a joint healthcare review of the issues that black and ethnic women had and an action plan would be drawn from that. Leicester, Leicestershire and Rutland were the only area in UK doing that as the demographics and diversity of the area were well recognised. As an example of the steps being taken, the Covid action plan was shared with Sharma and other women’s groups and feedback from them informed that plan was pitched right. In another example antenatal services during Covid were moved online with peer supporters and steps taken to get the same ethnic mix/language among peers.
It was queried whether the ethnicity of midwives working across LLR reflected the demographics of the area as a whole and any steps being taken to reach out to communities and allay fears about systems. Regarding the midwifery population it was noted there were not as many midwives from black or ethnic minority backgrounds in terms of percentages as the population of LLR and in Leicester there was an overall shortage of midwives. Recruitment was therefore broad to address the shortage and encourage diversity.
In terms of language barriers, language was an issue and there were processes in place for completion of questionnaires from GPs to identify if English was not the first language and to ensure interpreters were available at every appointment. Health colleagues tried not to use family members for interpreting as they were conscious, they might only say what they think the woman wanted to hear.
It was also found that a lot of women who did not speak English as their first language also lacked literacy skills in their own language and so leaflets were not always interpreted, however there was a facility online to translate voice over of information.
Members noted there was a distinction between the issues around medical care and the issues around systems i.e., communication and understanding practices.
Referring to medical issues it was noted that women of black and ethnic backgrounds tended to have more other risk factors such as diabetes and co-morbidities. Members noted that during the covid pandemic health colleagues were advised to change the way diabetes was tested during pregnancy and so clinics were set up at children centres and GP surgeries, so no-one was missed.
Regarding systems, health colleagues tried to treat people as individuals and there were groups that met where the midwife attended monthly to engage e.g., the midwifery service had regular access with the Sharma women’s group before covid and now restrictions were being lifted the midwifery service would be re-engaging.
In terms of cultural concerns around maternal mental health there were services for women to get extra support and access psychologists and women that went through traumatic birth were contacted. The service also tried to ensure continuity of care with one midwife throughout the pregnancy.
Members were reassured that LLR was not an outlier in terms of mortality however Members would have liked to see more data to support that with national/regional comparators as well as data that included the ages of women as that was a known risk factor.
It was confirmed that other data sets were available, and reports could be provided to that. Data on national comparators relating to mortality and older women would be shared if available outside the meeting.
Members expressed some dissatisfaction that the only data provided in the report related to Leicester rather than the wider area of Leicester, Leicestershire and Rutland, especially since this was a joint committee. The Chair agreed that data should be provided for the whole of LLR however taking the data provided it was still quite stark.
Members queried whether there was data or evidence revealing any links with infant mortality. It was advised that as this report remit was around maternal mortality other data sets were not included to avoid confusion. The Chair also expressed an interest in seeing any reflection in full term infant deaths.
The Chair commented in relation to the investigative processes following a death or traumatic birth and suggested consideration be given to seeking views of a non-medical advocate for the woman to gain another perspective. The Chair asked that issues of advocacy and that role should be explored further.
The Chair thanked health partners for the comprehensive report and in summary commented that the maternity partnership was appreciated however the committee would be interested in a broader sense of how that works and if it could be better.
1. That a report providing full details of maternity partnership arrangements be provided to a future meeting.
2. That data on national comparators relating to mortality and older women to be shared if available outside meeting.
3. That comparative data to that in the report for Leicester be provided for the wider area of Leicestershire and Rutland.