Siobhan Obodai-Payne is a senior midwife in London and also a mum of two small girls. She recently set up her own business, Precious Delivery, offering affordable private maternity care to reach the clientele that need care most, as well as a pre packed maternity bag.
We caught up with her to find out more about BAME healthcare inequalities, continuity of care, and how parents-to-be can support midwives.
‘As a black midwife I am acutely aware of the healthcare inequalities that are faced by BAME women who are up to 4-5x more likely to die during pregnancy,' says Siobhan.
‘I have been a qualified midwife for over 10 years and I’m very lucky that in the trust I work for health disparities are not present. I work in a busy London unit where the majority of our clients are from a Black and Ethnic minority background so all our clients are treated the same. But I have heard many stories and had black women who have reached out to me for advice as they feel they haven’t been listened to or cared for appropriately - so there are clearly still disparities present in some places across the UK.’
It has long been known that in maternity Black women have worse outcomes in comparison to their Caucasian counterparts.
The MBRRACE report 2019 (Mothers & Babies’ Reducing Risk Through Audit and Confidential Enquiries UK), found that the inequalities in maternal mortality by ethnic group were:
7 per 100,000 in White women
9 per 100,000 in Chinese/ Other women
13 per 100,000 in Asian women
23 per 100,000 in Mixed women
38 per 100,000 in Black women
This shows that Black women are 5x more likely to die during pregnancy or up to 6 weeks after in comparison to white women.
Ethnic minority groups are also disproportionately affected by socio-economic deprivation, a key determinant of health status. This is driven by a wider social context in which structural racism can reinforce inequalities among ethnic groups, for example in housing, employment and the criminal justice system, which in turn can have a negative impact on their health (Kingsfund, 2021).
The Covid-19 pandemic has also disproportionately affected ethnic minority communities, who have experienced higher infection and mortality rates than the white population. The reason for this seems to be multifaceted but is likely due to socio-economic factors and other comorbidities such as diabetes and raised BMI.
So, what needs to change and what can be done to improve the care of black birthing people?
‘In my opinion I feel that in order to improve outcomes for black women they should have access to more antenatal appointments.
‘Currently in the NHS appointments are scheduled based on parity (how many babies you have had). If it is the first pregnancy you get more appointments than if it is the second/third pregnancy.
‘Ethnicity is a risk factor for further tests in pregnancy, for example Glucose Tolerance Test to check for gestational diabetes. However, I believe that ethnicity should also be used when determining how many antenatal and postnatal appointments to schedule for a client. By seeing a client more and building up a rapport with her and the family she is more likely to feel comfortable enough to contact us when feeling unwell or unsure about anything.’
You’re a mum-of-two – what was your own pregnancy journey and birth experience like?
‘I became a midwife before I had my babies so my pregnancy journey was very informed and I had a lot of help at hand when I needed it. Both pregnancies were very different.
‘With my first pregnancy it was very easy but I developed high blood pressure towards the end (which is very common in Black women). Luckily I went into labour naturally at 38 weeks and baby was healthy and I recovered very quickly.
‘With my second pregnancy I developed PGP (Pelvic Girdle Pain) and could barely walk from 18 weeks. I worked as a full time Senior Midwife up until my second baby was born at 36 weeks. As she was premature she developed jaundice which needed phototherapy so we were admitted to the neonatal intensive care unit. In my postnatal period I developed high blood pressure which resolved about 6 months later. I was very well looked after throughout both of my pregnancies.’
Is midwifery continuity of care a solution to ensure all mums receive safe and personal maternity care?
‘Continuity of care is such an important model of care. This approach works to ensure that all women are seen by a small team of midwives or Obstetricians in order to develop bonds and trust between client a health carer.
'This will also help the health professional to create individualised care plans based on their clients’ needs, for example extra antenatal or postnatal appointments – which could really help save the lives of mothers and babies.’
Is there anything parents-to-be can do themselves to make their birth journey a more positive one?
‘In order to have a positive birth journey you need an open mind. You also need to take each day as it comes. There are plenty of educational maternity platforms online that have support for pregnant women.
'If ever in doubt, the hospital you chose to book with is always open so feel free to call and speak to someone – you are not alone!’
Why did you decide to set up Precious Delivery?
‘I set up Precious Delivery in order to help all pregnant women access affordable midwifery care at a time to suit them.
‘Working in the NHS, especially during the pandemic, I have seen first-hand how services have been cut, leaving women with lots of questions and feeling alone – but also women not wanting to come in to hospital due to fear of catching COVID-19. Now I am able to provide telephone consultations and advice when a woman needs it most.
‘It has been a dream of mine to be able to use my qualifications to help all women, as I really understand the care given by the NHS can sometimes be very rushed due to increasing demand on midwives with fewer resources.
‘During the pandemic pregnant women were advised not to go out as they were at high risk of catching COVID-19 so I set up a pre packed maternity bag so that women could relax knowing their maternity bag had been packed by an experienced midwife. This saved them visiting various stores for maternity goods but also saved them time having to pack their own maternity bags.
‘We include all the essentials needed for both mum and baby during the first 24 hours after birth. Along with these bags we also offer a free 15 minute 1:1 consultation. This is the only pre packed bag on the market sold by a Midwife but also offers free consultations.’
What has the response been like from mums-to-be?
‘The reviews and feedback I have received from women and their families has been overwhelming. We launched right in the middle of the pandemic but our bags have been a huge hit.
‘I get so much satisfaction from knowing I have helped someone. The term midwife means “with-woman” and by setting up my business I have been able to be with woman at a time when they have needed me most.’