MIDIRS Monthly - My PHD Journey

By Sarah Esegbona-Adeigbe on 29 May 2024

I worked as a clinical midwife for over twenty-five years, I qualified as a registered nurse and a midwife and soon after this completed a BSc in Health studies. My intention when I qualified as a midwife did not include working in education or research. I worked in numerous settings as a community midwife, labour ward coordinator and took a career break to spend two years in the USA, working as an obstetric nurse. However, I always had an interest in Black women’s health and wanted to contribute to improving their health care experiences during pregnancy. It was during my MSc studies, which I completed in 2010, that I became interested in maternal mortality. At that time, African women were seven times more likely to die during pregnancy compared to White women. This was particularly the case for recently migrated women and as my mother was a migrant Black African woman, I became motivated to research this area of midwifery.  My MSc dissertation, focused on the cultural practices of Black African women during pregnancy.  I disseminated my findings from my MSc studies, publishing my first paper in the British Journal of Midwifery on cultural competency for Black African women in 2011.  I realised the importance of culturally sensitive care during maternity care provision, and as I had already completed a  Haemoglobinopathy course, I set up a caseloading service for pregnant women with sickle cell and thalassaemia disorders during my most recent clinical role as a Fetal Medicine Unit ( FMU) midwife at St George’s NHS Trust. I also started to caseload Black women who were referred to the FMU with a fetal anomaly.

Maternal mortality rates did not reduce significantly for Black women in subsequent maternal mortality reports. There were several suggestions for why these racial disparities  continued and I realised the importance of research and how this was needed to improve healthcare for Black women. An opportunity to be seconded as an Honorary Midwifery Lecturer arose in 2011, when I became even more aware of the importance of research and evidence based practice. Hence, I decided to take up a full time position as a Senior Midwifery lecturer in 2013, where I had the opportunity to influence both midwifery students and qualified midwives, and share my knowledge of racial disparities in pregnancy and caring for high risk women.  I knew that I wanted to do a PhD to further develop this knowledge, and so to increase my research skills, in 2015, I completed a Postgraduate Diploma in Health Research at the University of Stirling. That same year, I became a mother and I  remember waiting in the antenatal clinic and counting the number of pregnant Black women and thought  ‘one of us is more likely to die than a White women’. I experienced what maternity care looked like from the other side as a service user and could see where issues may arise due to lack of individualised care. Hence, I decided whilst on maternity leave, during quiet times whilst breastfeeding, to draft my PhD proposal,  this was driven by  the sheer will to contribute to the evidence on Black maternal deaths. Findings from my ongoing PhD studies which I am due to finish this year, on cultural competency for migrant Nigerian women and midwives, has been shared widely on national and international platforms. The profile of Black maternal health disparities need to be kept at the forefront of maternity care. Research is the key that can unlock people’s minds and can be used to raise awareness and give a voice to the women who are unheard.

Sarah is currently an Associate Professor in Midwifery, Course leader and the Midwifery Equality, Diversity and Inclusion lead at London South Bank University and leads modules on Additional care and Altered Maternal health in childbirth. Sarah is an advisory panel member of the Maternity and Midwifery forum, a founding member and administrator of the Black Midwives Network Facebook group, a stakeholder member of the NHS Maternity and Neonatal Stakeholder Council and a steering group member of the James Lind Alliance/ RCM Research Prioritisation Setting Project. Sarah received an RCN innovation award for setting up one of the first labour triage units in London. She received the first Dora Opoku BAME award to fund her PhD studies, the Ann Steward award for commitment to midwifery practice and the Jean Davies Award for inequalities
in maternity care (joint award RCM) from The Iolanthe Midwifery Trust. Sarah is passionate about improving the pregnancy outcomes for ethnically diverse women
during pregnancy and facilitating their cultural needs. She has published several papers on cultural safety and cultural competency, Black African women and pregnancy, sickle cell anaemia and FGM and a book titled Transcultural Midwifery Practice. Sarah has contributed to RCN guidance on FGM during her role as a RCN midwifery forum committee member. She has worked in the UK and the USA and volunteered in Africa. Whilst working as a Fetal Medicine Unit (FMU) specialist midwife at St Georges NHS Trust, Sarah established a case-loading service for pregnant women with sickle cell anaemia and thalassaemia. Sarah is currently undertaking a PhD at the University of Hertfordshire exploring migrant Nigerian mothers’ and midwives’ perceptions of cultural competency in antenatal care. Findings show that women are not asked about their culture during routine antenatal care and midwives’ ability to deliver culturally competent care is impacted by societal, professional and organisational factors. This knowledge will be useful in reimagining and improving antenatal care provision for migrant Black women.