Training and guidance for neonatal health professionals need to be urgently reviewed to ensure babies from Black, Asian and minority ethnic backgrounds receive equitable care, the NHS Race and Health Observatory (RHO) has warned.
The RHO has published new research that raises concern about the use of tests to assess newborn babies that were developed “based on White European babies” and are therefore potentially unsuitable for infants with darker skin tones.
Specifically, the review, undertaken by Sheffield Hallam University on behalf of the RHO, looked at three assessments that require health professionals to look at skin colour when checking the health of babies minutes after they are born.
These include the Apgar test, which sees a health professional assess the baby’s skin colour, heart rate, reflexes, muscle tone and breathing. In terms of the skin colour element, some guidance says that the baby’s skin should be ‘’pink all over’’.
The review also covered assessments to detect cyanosis and jaundice, which involve checking the skin for blue and yellow colouring respectively.
However, the new RHO report warned that these descriptions had the “potential to disadvantage babies with darker skin tones” through “improper assessment or potential late diagnosis”.
As part of the study, researchers interviewed 24 parents and 33 health care professionals (HCPs) including 13 midwives, eight health visitors, four paediatricians, three obstetricians, three neonatologists, and two neonatal nurses.
Those interviewed raised particular concern about the use of the term “pink all over”.
The report said: “There was a general consensus from HCPs and parents that the term ‘pink all over’ in Apgar scoring is derived from observing White babies, and its relevance to babies from Black, Asian, and minority ethnic backgrounds was generally questioned.
“It was suggested that, due to the implicit bias within the Apgar score, continued use may be considered inherently racist in a multi-cultural society where infants hold diverse phenotypes.”
Meanwhile, some health professionals said looking for colour abnormalities in the lips, mouth and eyes could be more suitable for babies from minority ethnic backgrounds, rather than on the body.
The review also highlighted experiences of “discrimination and racism” in healthcare by people accessing maternity services.
It warned: “In both the literature and in the interviews, women reported assumptions about their education and lifestyle and felt HCPs labelled Black, Asian, and minority ethnic women as ‘aggressive’ or ‘difficult’.
“Parents and HCPs felt HCPs sometimes made unfounded racial assumptions about Black and minority ethnic women’s bodies and lacked cultural competence, resulting in over-medicalisation of childbirth and inadequate pain management.
“HCPs also overlooked potential difficulties due to women’s skin tone and failed to offer culturally tailored care.”
The report made a number of recommendations, including:
- Immediate update of guidelines that refer to neonatal assessment by skin colour to detail how they should be applied for babies from Black, Asian and minority ethnic backgrounds
- Medical devices should be used to detect jaundice and cyanosis instead of relying solely on visual assessment
- The creation of a national data bank of open access images of Black, Asian and ethnic minority neonates to incorporate into training and education for health professionals, as well as to aid diagnosis in practice
- Providing all students with experience – either in real life or virtually – in assessing Black, Asian, and minority ethnic babies during their studies
- Making sure all community and hospital staff receive training on “anti-racist practice” and providing “culturally safe, compassionate care”
Co-chair of the RHO’s maternal working group, Professor Jacqueline Dunkley-Bent, said: “The findings of this study show that we have much to do to ensure that women, babies and diverse people of colour receive the same healthcare, and have the same childbirth outcomes and experiences as those who receive the best.”
Responding to the report, Sally Ashton-May, director for midwifery policy and practice at the Royal College of Midwives, said: “We have got to double-down on all of our efforts to eradicate racism and discrimination from our health services as a matter of urgency.
“We live in a multicultural society and our health services and how we train our health professionals have simply failed to keep pace and recognise it; this must change and quickly.”