It’s a convention as old as our species (I’m guessing) that if you have a hideous experience giving birth, you don’t tell younger women about it in case it puts them off. Around this lacuna where the normal exchange of information should be, a number of wrong assumptions cluster, unchallenged: that all births are terrible, and therefore equally terrible; that something which happens to so many people can’t possibly count as traumatic; and that people should shut up about it and move on.
So when the all-party parliamentary group’s birth trauma inquiry delivered its report this morning, that was always going to land as new news. The accounts submitted to the inquiry by 1,311 women were appalling: pain relief denied, medieval levels of hygiene, chronic understaffing, lifelong injuries to them and their babies, caused by mistakes and failures that were later denied by NHS trusts. It’s estimated that one woman in 20 comes out of childbirth with PTSD.
It seems important to draw some lines, here, between “normal for childbirth”, “normal for the 21st century” and “normal for life under a Tory government”. The debate has already started to veer off to its happy place, where an interviewer will compare and contrast the modern experience with a woman who gave birth in the 70s and spent a week recovering on a well-staffed maternity ward, where midwives with all the time in the world would bring you toast and teach you how to swaddle. The much more salient comparison would be between the experience just before 2010, and the experience since.
I had my kids before austerity, in 2007 and 2009, and each time I had one midwife for the whole labour, which wasn’t at all unusual. I wouldn’t have known if either of them was overworked; I was their one job. Never mind – I could tell you both their names; I could tell you the name of the garage one of their brothers-in-law ran in Cyprus. I had the pain-relief faceoff, which again was pretty standard between mothers and midwives: you’d ask for an epidural and they’d go, “Too soon, not yet, just a bit more dilated, whoops, too late.” So afterwards, there’s a lot of indignation mingled with gratitude – a complicated emotional soup that tasted different according to your mood – but I honestly never heard anyone, in the 00s, describe being mocked or shouted at or ignored by their midwife.
Sure, that’s not data, that’s just vibes. And there was already evidence of racism in the system, pre-2010: women from black and minority ethnic backgrounds received less pain relief, and less kindness, during labour. A study nine years later showed no demonstrable improvement.
However, we have plenty of data about money and staffing: two years into the coalition government, half of all NHS health regions were cutting their maternity budgets, even as birth rates were at their highest for 40 years. In 2015, nearly 100,000 more babies were born than in 2001. The Royal College of Midwives (RCM) raised the alarm about staff shortages, which created a vicious circle: understaffed trusts were haemorrhaging money on agency staff, which left them unable to fund full-time positions, which would be cheaper in the long run. By 2016, half of all RCM members said they felt stressed at work every day or most days, citing huge workloads. A year later, more nurses and midwives were leaving the profession than joining it, so the government decided it was a great time to abolish the bursaries and charge students £9,000 a year. The policy took a little while to hit, but by 2022, 15% of trainee midwives were dropping out before they finished.
The authors of the birth trauma report call for a system “where poor care is the exception rather than the rule”, which is a strange way to put it: if you’re putting together a wish list, surely you’d hope to eradicate poor care? But that’s evidently just the most polite way they could find to say: this system is broken everywhere. It’s not a story of one bad apple, or one bad chief executive, or one bad institutional culture, or one underprivileged area. In 2022, 80 of the country’s 193 maternity units were deemed unsafe by the Care Quality Commission. That definitely wasn’t the austerity promise, not even in the small print: creating a country not safe to give birth in.
• Zoe Williams is a Guardian columnist
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