Maternity care is failing mothers and babies, and that is not only due to budget cuts | Letters

Report on pregnancy trauma is deja vu again (women undergoing ‘harrowing’ births while hospitals cover up their failures, says MPs report, May 13). I can’t read about it because it makes me scream.

A few years ago I was in the area for the Shrewsbury and Telford hospital trust report. All those dead babies, all those mothers and parents talking about not being listened to or being disrespected. All that hand-wringing from service providers, all those promises from politicians. The recommendations are designed to prevent the experiences we heard about this week (‘I was left lying on the floor in pain’: shocking stories from the British birth trauma study, May 13). For example, the continuity of obstetric care through the maternal pathway prevents many of the things we are now reading about.

A midwife you know and trust, and whom you know and respect – that should not be a dream, but an evidence-based, fully funded intervention to ensure the well-being of mother and baby.

I say to parliament and the royal councils: stop the crocodile tears and hand-wringing, and take action now. The solutions are there in the Better births report, the Kirkup report on East Kent hospitals, and go straight back to the 1992 Winterton report from the Commons health committee. Force the NHS to make them happen. Fund them to make them happen. Until then, all I hear is the voice of an abusive partner promising not to do it again—a promise that is never kept.
Ruth Weston
Llanfyllin, Powys

While austerity is clearly making the situation worse, it is not the only cause (the birth trauma scandal is not about one bad apple, one bad culture or one bad area – it is about the mess of austerity, May 13). I can still remember every detail of a traumatic birth in 1990, when a midwife kept coming over to scold me for being weak and telling me to pull myself together and deal with the pain. By the time I gave birth, I was too weak and exhausted to even think about my baby. I needed a transfusion as a result of the traumatic ‘natural’ birth. It took many weeks for me to get close to my child.

I chose not to have another child and am still experiencing the physical effects of the treatment I received (or didn’t receive). So I am forced to conclude that it is not just about austerity, but also a need for more empathy, understanding and responsiveness, or, to put it simply, listening to the mother, rather than treating her like someone otherwise in a series of cases occurring in the factory. every day.
Name and address provided

I had a very mixed experience of maternity care in a teaching hospital in London (St Thomas’s) in 1986, long before the cuts. I had a very difficult birth that required forceps, and I was extremely grateful to the midwife for delivering my son unscathed. But all the details of ridicule for asking for pain relief, bullying and intimidation are known. I remember being scolded for lying in blood-soaked sheets after birth and being yelled at to change the sheets myself. Then I had to wait two days for antibiotics for a hospital infection. I was too sick to breastfeed and we had to stay in that horrible ward for almost two weeks until my family came to my rescue.

Cutbacks are not the only reason. There is something else too: something to do with vulnerability and dependency that invites care in some, but cruelty in others. Thirty-five years later, my son and daughter-in-law had a very good maternity care experience.
Julia Davis
Burton, Dorset

The culture where mothers are not listened to, resources are scarcely used and birth trauma spreads rapidly did not start in 2010. In 2008, when I was 29 weeks pregnant with my first child, I spent a very lonely night in severe pain in the antenatal ward. , admitted as a precaution due to abdominal cramps. As I wandered around the ward trying to get help, I was told, “If I was in labor, I wouldn’t be walking around.” Around 5am I came to the conclusion that I was either in labor or about to die. Finally someone came to see what was going on. My son was born less than an hour later, more than 10 weeks premature.

I know many mothers who gave birth around that time and felt trivialized and violated by their birth experiences. Funding is essential, but it’s not just about money: we urgently need a culture change. Mothers should be treated with dignity and compassion, and not belittled or treated merely as a baby vessel.

The life-altering injuries and PTSD described in the birth trauma report are just the tip of the iceberg of a system in which the physical and emotional neglect of mothers has been routine for years. Covid and austerity have only made matters worse.
Camille Hamilton
Letchworth, Hertfordshire

A shortage of maternity staff is directly or indirectly the cause of many of the problems mentioned in the birth trauma report. But how is that possible when the number of midwives in Great Britain has been increasing for years? It’s true that pregnant women have become more medically complex and the amount of care we can provide has increased dramatically – but the problem is broader than that. Until twenty years ago, British maternity care was largely run like any other hospital service: the NHS decided what the optimal care for a woman should be and then provided it. It was like being a passenger on a flight: once you boarded, you simply followed the safety instructions without asking any questions.

The NHS is now moving towards personalized maternity care. In theory, women are now informed about care options (including their risks and benefits) and make their own decisions. But the time and costs required to achieve this are enormous. Maternity staff have always needed to know the recommended best practices. But they now also need to be able to explain to women the evidence behind both the best practices and the other options that are not recommended. Every decision must be justified, explained and typed out in detail.

Staff must also be adept at guiding women who do not wish to follow the recommended best practices but choose alternative routes. And so the need for detailed notes and elder care is even greater given the current level of litigation.

Personalized care is ideal, but expensive in time and resources. Using the airplane analogy again, if flight attendants had to discuss with each passenger a choice of safety features based on evidence (“How much does my chance of dying increase if I choose to be in the lavatory before takeoff?”), it is clear that the number of flight attendants should increase in number and their training should change.

Everyone agrees that maternity care needs to be improved. Unfortunately, many of the well-intentioned efforts to improve maternity care—particularly personalized care and electronic notes—have not been accompanied by the necessary workforce expansion. Add to this increasing scrutiny, public ‘pregnancy scandals’ and lawsuits, and it’s no wonder there are record levels of stress and staff departures. This creates a vicious cycle where those left behind are stressed, busy and not in the best mood to provide the care they want.

Only with a major expansion of the workforce will we be able to provide the quality of care we want and that women deserve.
Prof Andrew Weeks
Consultant Midwife, Liverpool Women’s Hospital; Professor of International Maternal Health, Department of Women and Child Health, University of Liverpool

I am a midwife of 14 years and completely agree that budget cuts are the problem. A labor department is a great place to work. The majority of midwives and midwives are – I hope – friendly and compassionate; they had a calling and they want to be there. But lack of funding and staff will let us down every time. It is important that these matters are investigated, and the report is welcome and necessary. However, you can conduct as many studies and write as many policies as you want; restoring maternity care will only be possible if you recruit more midwives and employ more per trust. Pay them to train, don’t make them pay. Double the number of midwives in the wards.
Amelia Evans
London