That the findings of the first British study into birth trauma are far from surprising does not detract from the fact that they are shocking, devastating and difficult – even harrowing – to read. The 80-page report from the All-Party Parliamentary Group (APPG) on Birth Trauma should give ministers, NHS bosses and the midwives and midwives who provide care some serious food for thought.
It highlights how “mistakes and failures” by maternity staff lead to stillbirths, premature births, babies being born with cerebral palsy because they were deprived of oxygen at birth, and “life-changing injuries in women due to severe lacerations”. How some mothers were mocked, verbally abused, denied pain relief, not told what was happening during childbirth, left alone in blood-stained sheets, while desperate calls for help went unanswered – all examples of ‘care lacking compassion’ . And how, in some cases, “these mistakes were covered up by hospitals that frustrated parents’ efforts to find answers.” It amounts to a shameful catalog of negligence in the only area of NHS care where two lives – one still unborn – are at stake.
Given this record of poor care, it is easy to see why settling legal claims for medical negligence in childbirth now costs the NHS in England £1.1 billion a year. As the Commons Public Accounts Committee noted last week, that figure is “equal to an eye-watering third of the entire NHS maternity and neonatal services budget”.
Maternity care has been one of the most problematic, inadequate and dangerous areas of NHS care for many years. Three major investigations since 2015 into pregnancy scandals – at the Morecambe Bay, Shrewsbury and Telford and East Kent NHS trusts – have produced heartbreaking testimonies and carefully considered, often recurring recommendations for change.
A fourth investigation is underway into claims that hundreds of babies and mothers have been harmed by poor care at the Nottingham University Hospitals NHS trust. Nottinghamshire Police has also launched a criminal investigation into the concerns of what started as 700 – and is expected to reach 1,800 – families.
Each of these first three studies has led to a flood of ideas to improve care, and ministerial and NHS commitments to implement them. But, as noted by Angela McConville, the director of parenting charity NCT, the APPG’s conclusions show that “we hear the same problems being identified repeatedly, including not listening to women, delays in receiving care, poor communication, the absence of compassion and cultural competence, and the lack of continuity of care.” And that a series of reports have shown only “slow progress on birth-related trauma.”
So what else needs to be done to finally make maternity care safe? The APPG has drawn up its own twelve-point plan. It aims to sweep away a “maternity system in which poor care is too often tolerated as normal and women are treated as an inconvenience” and usher in a system “where poor care is the exception rather than the rule”. It is necessarily an ambitious goal.
The MPs recognize that maternity care is a “system in which overwork and understaffing are endemic”. However, many of their suggestions go some way to addressing the ongoing and widespread shortage of staff, particularly midwives, but also midwives, who – such as the Care Quality Commission, the Royal College of Midwives and the Commons Health Select Committee argue – enabling safe, personalized healthcare. and high-quality care that everyone wants all mothers to receive and which in practice is impossible to deliver.
More midwives would be needed to implement the APPG’s suggestions: that fathers be kept informed of how things are going during labor; that women receive the continuity of care that they value so highly; that major racial disparities in pregnancy outcomes are addressed; and that all NHS trusts offer antenatal classes. But while the NHS workforce in England has grown by 175,000 since the December 2019 general election, there are now 48 fewer midwives.
This casts serious doubt on the feasibility of MPs’ first and most important recommendation: that a new national pregnancy improvement strategy, led by a maternity commissioner accountable to the Prime Minister, should set out ways to “recruit more midwives, obstetricians, to lead and preserve.” and anesthetists to ensure safe staffing levels in maternity care”. Unless that happens, it’s difficult to see meaningful improvements take place.
However, more workers are leaving than joining an essential care area where joy should be plentiful, but pressure is high and inadequate care is all too common. This suggests that the APPG’s findings will not prove to be the turning point that maternity care so desperately needs.