Manjula: racialised stereotypes about pain in labour
Setting: Maternity care: labour ward triage.
Context
Manjula is a South Asian woman having her first baby. She calls the labour ward to say she is in a lot of pain and then arrives with her mother and mother-in-law supporting her on either side as she walks slowly towards reception.
What happened
As Manjula approaches the receptionist, she has a contraction, screams in pain and says she feels faint. The team rushes out with a wheelchair and takes her to a triage room. On examination, Manjula is found to be 2cm dilated. Further observation shows contractions around ten minutes apart.
As the midwife walks out of the room, she says to colleagues: “Just another princess.” The team is not aware that one of the older women is a GP and understands the racialised stereotype behind the comment.
The next day, the family makes a complaint about the midwife’s comment. The Director of Midwifery who receives the complaint does not initially understand what the phrase means. After meeting with the family, the Director of Midwifery apologises on behalf of the team and prioritises anti-racism within future mandatory training.
Impact
Manjula and her family experience the comment as dismissive, stereotyping and racist.
It undermines trust at a vulnerable moment when Manjula is in pain and seeking care.
The incident also reveals a gap in staff and leadership’s understanding of racialised tropes about pain, behaviour and femininity.
What anti-racist practice should look like
Pain and distress must be assessed individually and respectfully. Staff should not use racialised, gendered or cultural stereotypes to interpret how a woman expresses pain. Leaders should understand racist tropes and ensure that complaints lead to learning, accountability and culture change, not only apology.
Key learning points
- Understand that anti-racist behaviour is essential to kind, compassionate and safe care
- Women should be treated as individuals and not stereotyped in how they experience or express pain
- Casual comments can reveal harmful assumptions and create mistrust
- Racist tropes must be recognised, challenged and eliminated from workplace culture
- Bystanders should challenge discriminatory comments when they hear them
- Complaints should be handled with openness, curiosity and accountability
- Training should be accompanied by reflection, supervision and leadership action
- Respectful pain assessment is an equity and safety issue.
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