Maternity care in Britain has found itself under a worrying spotlight this year.
Inquiries have highlighted alarming failures in NHS hospitals that have led to dozens of avoidable mother and baby deaths while others have revealed inequalities that mean Black women in the UK are four times more likely to die in childbirth.
Calls for change should be too loud to hear – but those on the frontline know too well that lessons can go unheeded.
Eight years ago, London-based consultant obstetrician and gynaecologist Dr Benjamin Black spoke to Metro after he found himself at the centre of the Ebola outbreak days after arriving for his first humanitarian mission, in Sierra Leone, west Africa.
‘I was one of very few international workers present throughout the outbreak, who saw the whole trajectory,’ he now explains to Metro.co.uk. ‘There were very few voices able to tell those stories.’
Since then, Dr Black has turned his experiences into a book that sheds light on the plight of the pregnant women he encountered as the epidemic moved across the country, and brought a devastating, ‘too many to count’ death toll into the maternity tents where he worked as a maternal and reproductive health advisor to humanitarian aid organisations.
Called Belly Woman, it has been described by Adam Kay, the former doctor and best-selling author of This Is Going to Hurt, as: ‘Moving, kind, eye-opening, terrifying and inspirational.’
Through the pages – some of which have been extracted below – Dr Black reflects on how mothers were let down by huge, international socio-economic inequalities and a poor response to the deadly disease.
He also intersperses his account with parallel moments from his work on London’s NHS maternity wards during Covid. The coronavirus pandemic may have taken place six years after the Ebola epidemic, but according to Dr Black, lessons went unlearnt.
‘Maternal mortality is an epidemic in its own right,’ the 41-year-old NHS consultant, who has advised on humanitarian and Covid maternal health guidelines, working with government and the UN, tells Metro.co.uk.
‘Every death is avoidable. In the UK, you can work as a midwife or obstetrician, have a full career and never see a woman die; to then see women and girls die in front of you from something entirely avoidable – bleeding, infection or a back street abortion – that was the hardest thing to process. Those are clinical diagnoses but prevention is society’s responsibility.’
In 2014, Sierra Leone had the highest death rate of pregnant women in the world, as mothers travelled miles for care, sometimes arriving too late for life-saving treatment.
An extract from Belly Woman: Birth, Blood & Ebola: the Untold Story
Bo/Kailahun, Sierra Leone
The epidemic was out of control. Every day, we were receiving more patients. They were arriving from increasingly far away, meaning longer journeys squeezed in the back of ambulances, bouncing along those terrible roads. By the time the ambulances arrived, we would ﬁnd patients who had died en route, and patients lying, dazed, next to them, disorientated and dehydrated.
We took turns to run around to the ambulance bay, assessing the condition of the people in the back of the vehicles. Standing a couple of metres away, we would shout to the passengers inside, ‘Open the window! How many of you are there?’.
We tiptoed to see through the crack of the ambulance window. Trying to count patients and see if anyone was on the ﬂoor. Conferring with one another what our next steps should be.
The ambulance drivers often did not know themselves what or who they were bringing. They were unsung heroes, providing a vital service. Transporting infected people was a hazardous job. I do not know how many of those drivers became infected; I do remember those dark days when we would isolate familiar faces: soldiers from the front line. Incredibly, there were drivers who, having survived Ebola and witnessed all that death inside the ETC, went back to continue their essential work, showing a strength that does not exist in many people. Those drivers saved uncountable lives.
Looking back now, I realise I did not appreciate the drivers and the work they did. They all wore some form of PPE – terriﬁed, I assume, of getting infected and taking the disease home to their families. They would be drenched in sweat, having driven in the impermeable suits. We would give them bottles of water to rehydrate and, once the patients (alive and dead) were unloaded, the ambulance would be sprayed inside and out with chlorine to decontaminate it.
On instruction, and quite sensibly, we would not touch anything from the ambulance. The referral papers for patients coming from other hospitals would be held only in gloves and read out to someone else to copy the information down. The driver, their ambulance and all that was in it represented an Ebola twilight zone. They were neither infected nor free of the risk of onwards transmission, and yet they were fundamental to the ﬁght.
Those ﬁnal weeks of August are a time I see like a ﬁlm. I’m not there, I’m watching it all play out on screen. The ETC [Ebola Treatment Centre] had been expanded twice to meet the needs of increasing patient numbers, and still we were struggling. There were now eighty beds, and it was not enough.
I would often go in the early hours of the morning to collect blood samples and insert IV lines. During those morning rounds, we also took note of which patients had not survived the night. There were so many patients coming in and out, we relied on their numbers to identify them and to know where in the ETC they were located. They represented bed spaces we could empty for the next round of sad and confused souls to arrive.
We were witnessing death on a scale no person or people should ever experience. The young, the old, those in the prime of life, stronger and ﬁtter than I will ever be, bent and bleeding, begging for help, while lying curled in their own uncontrolled vomit and excrement.
Often, a person would die with their back painfully arched and limbs upright and ﬂexed – the typical position of a person who has died from their brain swelling. Rigor mortis would freeze them, like a statue from a Greek tragedy. Their twisted form caused great diﬃculty when laying them to rest in the body bag.
Death became so familiar it was a passing comment, a matter of fact. ‘Thirty-one, thirty-ﬁve and forty are dead; we’ll need one child and two adult body bags.’ I am chilled to think how those words rolled so easily oﬀ my tongue. It was just work. We had to get the dead out to get more living in, and so the wheel turned.
Belly Woman: Birth, Blood & Ebola: the Untold Story by Benjamin Black, £10.99 (paperback,) is published by Neem Tree Press and available from Waterstones, Amazon and other bookstores.
Back in the UK, when Covid hit, Dr Black pulled his experiences there and in other humanitarian zones, like South Sudan, East Timor and the Central African Republic, into his professional response.
His hospital, The Whittington, in north London, allowed partners into births, throughout lockdown, at his bidding. He explains: ‘I championed rights for women to have birth partners with them from the start. That was directly related to my work during Ebola, seeing that health services were not places people should be afraid to go or feel alone.’
As a child of the Live Aid generation and a household heavily shaped by its descent from Iranian and European refugees, Dr Black felt inspired to go into humanitarian work. He is conscious, however, of ‘white saviour’ accusations, in sharing what he saw.
‘The enormity of writing about the peak of the outbreak where we were seeing so much suffering, so many people’s stories that would never be told, I found putting that on the page a huge responsibility,’ he explains. ‘I cried as I wrote sections. The images are still very haunting.’
As a doctor at the coalface of an epidemic and a pandemic less than a decade apart, which lessons does he feel went unlearnt?
‘Everything,’ says Dr Black. ‘When Covid happened, I felt the lack of all we should have been prepared for – available testing, tracing, good communication – immediately. It was complete deja vu.
‘They were very different situations but similar frustrations. We’re very good at identifying lessons, what went wrong, what should have happened and what actually happened – then we stop.’
Earlier this year, Dr Black was a panel-member for the charity, Birthrights, which reported systemic racism in UK maternity care following a year-long inquiry.
‘Maternal deaths are the end of a road where there are many opportunities to stop things getting to that point. That’s the whole gamut, including access to safe abortion care, contraception and girls’ education.
‘If, as an international or domestic community, we don’t have these things in place before there’s an emergency, you can be sure they’re going to be worse once it happens and the people who suffer most are going to be the ones who were already the most vulnerable and marginalised.’
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