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Recent reports from the NHS Race and Health Observatory (an independent body created to examine ethnic inequalities), and the Government’s Healthcare Safety Investigation Branch (HSIB) highlight that ethnic minority babies are at a greater risk of inaccurate assessments, late diagnosis of conditions and poorer outcomes than white babies.
The nub of the matter would seem to be that assessments of newborns still use subjective diagnostic tests and guidance which have not been adapted to account for skin colour. Updating of maternity guidance, among other changes, is urgently called for by the Observatory and is undoubtedly needed.
Apgar score
The Apgar score, developed in 1952 based on white European babies, is a measure of the physical condition of a newborn, obtained by adding up points for various factors including heart rate, muscle tone and skin coloration. All babies receive this assessment in the first 10 minutes after they are born.
A traditional element of the test, still used within some guidance, is whether the baby is ‘pink all over’, which would suggest sufficient oxygen levels. Researchers at the Observatory found that many healthcare providers were uncertain how to adapt the Apgar score to non-white babies and this can lead to inconsistent scoring. Their report strongly recommends that a pulse oximeter (a device measuring pulse and oxygen levels) should be used where there is any concern over oxygenation.
Jaundice
Jaundice is a condition caused by a build up of bilirubin, a yellow substance produced when red blood cells are broken down. It is common in newborn babies, particularly those born prematurely, and can be treated relatively easily. However, if left undiagnosed it can be extremely serious and lead to kernicterus, a condition that can cause brain damage. When this occurs, claims for medical negligence are often made.
A key indicator of jaundice is yellowing of the skin. As a result, diagnosing jaundice in babies with black and brown skin is more challenging, resulting in some babies becoming severely unwell through delays in diagnosis. Despite this being widely recognised, more still needs to be done. The Observatory recommends wider use of a hand-held device to measure bilirubin levels and the creating of a data bank of images of ethnic minority babies for use in training.
Enduring racism in maternity care
This all comes on the heels of shocking evidence that there remains a significantly higher rate of still birth and neonatal death in babies from ethnic minority groups and that, in the UK, Black women are four times as likely as white women to die during pregnancy and childbirth and Asian and mixed-race women are twice as likely.
In recent years, there have been a variety of studies dealing with failings in maternity care and the disparities in outcome based on ethnicity. Last year, the charity ‘birthrights’ produced a report – 'Systemic racism, not broken bodies'– which found that Black and Asian women using maternity services regularly faced being ignored or not believed in regard to their concerns. The report called for urgent action at all levels and stated that the Government and NHS needed to recognise the role that racism plays.
Despite this, a recent House of Commons Women and Equalities Committee report into 'Black maternal health', stated that the Government and NHS had not done enough to address the problems. Chair of the committee, MP Caroline Noakes, said: 'We are also afraid the Government and NHS have not fully grasped that racism has played a key part in the complex reasons underlying the disparities, and that eradicating it is part of the solution’.
She went on to say: ‘Government must be more ambitious and set a national target to end disparities. It is frankly shameful that we have known about these disparities for at least 20 years. It cannot take another 20 to resolve.”
In response the Government has acknowledged that it ‘must do more’ to ensure consistency of maternity care regardless of ethnicity, but has rejected the recommendation to set a 'concrete target'.
If you would like to discuss any concerns around maternity or neonatal care, our team of specialist medical negligence lawyers are here to help.
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