“I’m very saddened but not at all shocked by what I’ve read of Donna Ockenden’s report. I’m sad about the treatment that the women received and that they were never listened to or had their complaints investigated properly. Unfortunately, though, I’m not surprised by any of it.
I feel like the same things that were revealed in Shrewsbury and Telford could be occurring in the majority of maternity units in the UK. I say that because we are chronically understaffed. Every time you come on shift you don’t have enough people to deliver a safe service. That understaffing is widespread across the NHS. And that lack of maternity staff is risky for mothers and babies.
We don’t have enough bodies on the ground. It’s not just midwives, though. We’re also short of obstetricians, maternity support workers and admin staff, too. That means that midwives end up getting stretched doing lots of things that could easily be done by someone else, like filling in paperwork so that a mother can go home with her baby. As a result their skills, especially to monitor women and babies, aren’t used.
And that’s how things can get missed, such as a baby’s heartbeat becoming irregular or the mother developing a problem. Delaying monitoring someone means you’re going to miss opportunities to intervene earlier in a situation. Monitoring is vital. But if midwives don’t have the time to do it then problems can occur. That could be the monitoring of foetal growth in the antenatal period, which Ockenden found was a problem at Shrewsbury and Telford. Or it could be monitoring a baby’s heartbeat during labour and delivery. Or it could be monitoring women’s mental health after they’ve given birth. If you don’t have the time to sit and actually be with women and understand what they’re experiencing, and listen to their concerns, then you miss a lot of the clinical picture. But there aren’t enough staff to monitor women and babies reliably all the time. And the impact of that on mothers and babies is enormous.
Mistakes also happen because we don’t listen to women effectively, which again is closely linked to the time pressures midwives are under, because maternity services are full most of the time. We know best. When women raise a concern we can say: ‘Oh no, this is OK because of X, Y or Z.’ But then when you review their notes later you see there were missed opportunities to improve their care.
Ockenden also found that there was a culture of reluctance to perform caesarean sections at Shrewsbury and Telford, which led to babies dying during birth or shortly after. And I recall that the report in 2015 of the Morecambe Bay maternity care inquiry found the same thing there, too. I’ve not seen that reluctance in any of the delivery suites that I’ve worked in. But I do recognise that the Royal College of Midwives had a whole campaign around what they call ‘normal birth’ and are now backtracking from that quite rapidly.
Childbirth is inherently risky. However, midwives and obstetricians have a different standpoint on what constitutes risk and that leads to some of the problems in communication between them. I think we midwives struggle to work alongside obstetricians and anaesthetists too as part of the multi-professional team that women need during their care. And as a result we miss things, not just when there’s an emergency but throughout the whole pathway of maternity care.
The saddest bit of the Ockenden review for me is seeing how rude NHS staff were to mothers. When you start to get this chronic understaffing you also start to lack civility to your colleagues and compassion to those that you’re caring for. And those are the things that stay with mothers, that they weren’t listened to and weren’t treated with proper compassion.
Midwives feel beaten-up at the moment and exhausted – absolutely exhausted – after two years of Covid, the review of maternity care, all the media focus on that and staffing pressures. I don’t want this to be a situation where we say ‘midwives are not doing a great job’. Midwives working within well-supported structures help save women’s and babies’ lives. But we are not well supported. And that’s when the failings come. We need to be well supported and that’s not happening.”
