LLike previous investigations into failings in maternity care, the birth trauma report published on Monday was prepared by a campaigner with first-hand knowledge. After a 40-hour labor during which she suffered a third-degree tear to her perineum, followed by surgery without a general anaesthetic, Theo Clarke was shocked by the poor care she received in a ward. Last October, Ms Clarke, the Conservative MP for Stafford, led the first British parliamentary debate about birth trauma. This week his report marks the culmination of months of work by the cross-party group she chairs.
Drawing on expert evidence and that of 1,300 people who have written about their own experiences, the report vividly depicts the human cost of past failures. One of Ms Clarke’s aims was to break the taboo surrounding birth trauma. Here are harrowing details about the physical and psychological consequences when labor goes wrong and care is inadequate. Birth trauma means overwhelming stress related to childbirth that has a negative effect on health. Approximately 30,000 women (between 4% and 5% of all new mothers) are diagnosed with post-traumatic stress disorder every year. Risk factors include complications leading to delivery by caesarean section or the use of forceps, and previous psychological problems.
Most of the 600,000 births that take place in England each year are not traumatic. Trauma is the exception, not the rule. But MPs are right when they say it should be much rarer than it is. The focus on the specific issues faced by women with birth injuries is important. Some people may be shocked to learn that childbirth can lead to lifelong fecal incontinence. A senior doctor told the inquiry that one of the reasons why women are not warned is that they may ask for a caesarean section because they are afraid.
Some findings mirror those of previous reports. These include issues around communication and consent, a lack of care and empathy from staff, poor administration, a lack of transparency and accountability for mistakes, and significant racial and socio-economic disparities – with black and Asian women having much worse outcomes, together with vulnerable groups, including care leavers.
Other issues include the difficulty of accessing treatment, especially after birth. The rivalry between doctors and midwives that has led to previous failures in maternity care, for example in Morecambe Bay, is not strongly reflected in this report. But practices embedded in NHS obstetric medicine, for example the continued use of forceps, are emphasised. These instruments are used in 7.5% of births in England, compared to 0.5% in Sweden and Austria.
Maria Caulfield, the Minister of Health for Women, apologized on Monday to mothers who have suffered harm. Amanda Pritchard, head of NHS England, agrees that the standards are “not good enough”. The backdrop against which improvements must now be made is extremely challenging. One expert’s evidence focused on the struggle to retain experienced midwives.
With the Care Quality Commission ruling that almost two-thirds of maternity wards are not safe enough, the need for a system-wide upgrade is obvious. This report’s recommendations, if implemented, would be a good start. The most important thing would be the adoption of a national minimum standard, laid down in a single document. This should include a new right to improved postnatal checks – with the workforce to deliver these. At a time when thoughtful, cross-party policy initiatives are scarce, this is valuable work.