Training maternity and obstetric staff in Devon to tackle perinatal bias

Katherine Morgan and Hannah O’Sullivan, midwives at Torbay and South Devon NHS Foundation Trust, have been ‘trained to train’ fellow frontline maternity and obstetric staff to tackle implicit bias and stereotyping in the care of mothers and babies from black, Asian and minority ethnic families via a model funded and evaluated by Health Innovation South West.   

Here Katherine and Hannah reflect on unconscious perinatal bias, their training experience, and the impact the training is having on maternity services in Torbay and South Devon.   

On a need to address unconscious bias 

“In Torbay and South Devon we don’t have a lot of exposure to cultural differences. As Specialist Public Health Midwife [Hannah] and Education Lead Midwife [Katherine], we felt we had a responsibility to address how we approach perinatal bias in our department. We thought it important to open the conversation and to think about the impact of our decision making and the care that we provide.” 

 On taking part in the training 

“Health Innovation South West gave us the opportunity to take part in Perinatal Bias and Newborn Assessment training and ‘Train the Trainer’ training in their innovation space in Exeter in 2023 (pictured below).  

For us it was about looking at ourselves, looking at our own unconscious biases and recognising that we all have them. How can we change if we don’t start with ourselves? 

It was also about addressing uncomfortable questions and discussions. Some participants had experienced situations of implicit perinatal bias and it evoked valuable conversations. 

As we were going to be delivering Perinatal Bias and Newborn Assessment training, we were there to train as a trainer as well. So, we asked different questions, and our discussions went deeper.  

The Health Innovation South West team sent us away with a package of resources, to enable us to deliver the training to our colleagues in Torbay.” 

Photo: Attendees at the Perinatal Bias and Newborn Assessment training

On taking the training to Torbay  

“Our maternity department mandated Perinatal Bias and Newborn Assessment training after we attended the session at Health Innovation South West.  

All midwifery and obstetric staff are now allocated time to complete the training on our mandatory training day. Our compliance level is over 90% for midwives, maternity support workers, and 100% for consultant obstetricians.  

On changing clinical practice  

“The course is improving the way we deliver culturally competent care in Torbay maternity services.  

We use mannequins of colour on the rescusitaire [breathing device for clinical emergencies] when training staff in newborn life support.  

We’ve looked at our equipment to understand if it is calibrated for certain skin tones. For example, pulse oximeters are only calibrated for Caucasian skin tones.  

We now have a better understanding of the most appropriate way to assess jaundice in babies from black, Asian and ethnic minority families in the community.  

When we carry out fetal monitoring training, we have changed the terminology we use to depict the colour of a baby’s skin. You’ll hear staff saying skin is “well perfused”, rather than pink.   

We’ve added a new question to our SBAR (Situation, Background, Assessment, Recommendation) tool, so if a woman rings triage, we ask about their ethnicity and record it appropriately. 

We realised we didn’t have body maps on SystmOne, our electronic patient record system, but we do now. We use the body map to accurately record birth marks for example, this helps improve written communication from advice calls, and helps us give the right advice to parents when they call in.  

We have signposted to publications, books and resources online that community midwives can use with women of different ethnic backgrounds. 

When we talk more about these changes and why, we keep them at the forefront of our minds. It’s so important.” 

On feedback from trained staff   

“They’ve enjoyed it. Many staff are glad to explore the terminology we use in perinatal care and have found it valuable to better understand what language is most appropriate to use.” 

On what’s next  

“We would like to expand our training to look more at the clinical picture as well as the human factors.  

The approach is ongoing. This is only part of a process that we are going to build on here at Torbay. They’re small steps, but we’re getting there.” 

About Perinatal Bias and Newborn Assessment training 

Perinatal Bias and Newborn Assessment training addresses inequity in perinatal care by providing training on implicit bias, stereotyping and clinical assessment of babies from black, Asian and minority ethnic families.    

To maximise impact from this training across the South West Peninsula, Health Innovation South West funded the founding midwives to develop a ‘Train the Trainer’ model of training to enable practitioners in maternity services to spread the training through their organisations.  

Our evaluation of the Train the Trainer model shows the course increases participant understanding of the impact implicit bias may have on the provision of care for and instils participants with the confidence to deliver Perinatal Bias and Newborn Assessment training within their own organisations.  

Learn more in our case study and read the evaluation in full here. 

With thanks to Katherine Morgan and Hannah O’Sullivan for their time and their ongoing commitment to encouraging culturally competent perinatal care in the South West.