Talking with strangers and unconscious bias in the NHS Maternity System

This blog is dedicated to Sandra Bland with love to her family #SayHerName ❤️

I have just finished reading the book “Talking to Strangers” by Malcolm Gladwell

The book is a critique of how we approach others through our body language speech, demeanour plus the various cues that we interpret or misinterpret according to our own life experiences, culture, colour , upbringing, religion or non religion , education , training ,inner feelings at that time and individual roles plus many other factors too numerous to list . One particular woman who in the book was Sandra Bland a black woman who was forced to change lanes on a highway because a police car was approaching with speed – the officer totally misinterpreted Sandra’s distress at being pulled over – he wasn’t kind with his words or approach and this led to Sandra being wrongfully arrested and she died in her cell three days later the verdict was suicide . When you listen to the recording of the officers first interaction with Sandra you can sense the irritation and suspicion in his voice as well as the tone he uses. He doesn’t see that Sandra may have vulnerabilities and that she is trying to calm herself by lighting a cigarette .

As a midwife I have witnessed disparity of care towards women depending on their social status, background, colour, culture and ethnicity- something I have challenged throughout my career . These experiences have often placed me in some difficult situations with colleagues. On one occasion I refused to allow someone from finance dept into the woman’s labour room . This years (2019) RCM International Day of the Midwife campaign was around Midwives as defenders and I wrote a blog about my interpretation of this . We must approach women placidly and an excerpt quote from the poem Desiderata by Max Ehrmann © 1927 illustrates this rather well.

“GO PLACIDLY amid the noise and the haste, and remember what peace there may be in silence.

As far as possible, without surrender, be on good terms with all persons“

Unconscious bias is something we all have – This animation by Professor Uta Frith of The Royal Society explains unconscious bias in a concise way . It’s the 21st Century – time for all NHS staff to be educated, assessed and held to account around the subject of unconscious bias plus to question their own personal identity around this issue .

Here is a photograph of part of the philosophy of the Royal Society panel members – a philosophy for the NHS .

Whilst writing this blog I also came across this refreshing blog post for By ‪@SuzRankin‬ CEO of Ashford and St Peters NHS Foundation Trust, Chertsey , Surrey .

If you are a midwife I want you to start to question the way you speak to women and families that you meet and whether you treat each woman or person exactly the same despite their background , culture , colour, sexual orientation and education. Make an attempt to hear yourself as the woman hears you – be patient and thoughtful with your words and actions . Watch how other midwives speak about the women they care for (at the bedside and in the office ) and monitor one another for unconscious bias .

Did you see someone give the woman everyone recognised from a TV programme better care than the woman who arrived unannounced from the local homeless shelter ?

Please question everything you see and if you talk about it more when reviewing cases of different women you might see a pattern start to occur – that’s what you need to change. Does your incident reporting system include statistics on race , sexual orientation, religion and ethnicity? If not how can such incidents be thoroughly evaluated ?

How do you talk to the women you meet as strangers ? When you show patience, kindness, compassion and understanding you are building on the relationship and helping the woman to feel safe . This behaviour has an effect on the woman’s oxytocin response as her adrenaline and cortisol will be reduced as well as her own fears . You are putting her at ease – becoming a friend . If on the other hand you are brusque , rushed , impatient and critical you will put the woman on edge and increase her fear , pain and cortisol which will inhibit oxytocin production.

Are you pre judging a woman when she phones up the hospital for advice ? Does that judgment impact on the way you interact with the woman ? Do you feel calm or under pressure? Are you more or less patient with her in comparison to someone else you’ve recently cared for ? Are you imparting information and evidence of equal quality or do you feel a change in your own demeanour which may make the woman feel uncomfortable without realising?

Reflect on a situation when you didn’t feel listened to – that may have been a complaint to a store or a the way an employee at a restaurant/ service / shop spoke to you – do you recall how you were made to feel or how you reacted?

Black and Asian women have a higher risk of dying in pregnancy as the November 2018 MBRRACE-UK triennial report shows and as midwives we must question why this is happening as well as campaigning for this tragic disparity to end .

I will leave you with a quote by Paul Coelho