Background

Clinical deterioration in mothers and babies with darker skin tones (DST) is more difficult to detect using traditional visual assessment cues. Despite national attention on inequity and mortality disparities, limited research explores midwives’ knowledge and experiences in recognising deterioration in DST in UK maternity settings.

Aim

To evaluate midwives’ knowledge in recognising clinical deterioration in DST and to explore perceived barriers and facilitators influencing assessment.

Methods

A mixed-methods online survey of 150 NHS midwives in one primary NHS trust to assess knowledge across 10 clinical scenarios (score range 0–10). Quantitative data were analysed descriptively and using t-tests/analysis of variance (ANOVA). Qualitative free-text responses were analysed thematically.

Results

Ninety-eight midwives responded to the survey. Mean knowledge score was 7.52/10 (SD 1.49). Participants scored highest on perineal assessment, mortality risk and oedema but showed significant gaps in recognising jaundice (61.2% correct), cyanosis (66.3%) and newborn skin conditions (64.3%). No significant differences were found by age, years qualified, education or ethnicity, suggesting systemic, not individual, knowledge deficits. Qualitative analysis identified five themes: training and knowledge gaps; clinical uncertainty and compensatory strategies; structural and contextual barriers; protective factors; and practice adaptations.

Conclusion

Midwives demonstrate solid general knowledge but lack DST-specific assessment confidence, particularly regarding jaundice and neonatal skin assessment. System-level reforms like mandatory DST education, inclusive visual resources, improved lighting and equipment calibration, and structured multidisciplinary support are essential for more equitable clinical outcomes.