That the findings of the UK’s first inquiry into birth trauma are far from surprising does not diminish the fact that they are shocking, devastating and difficult – indeed distressing – to read. The all-party parliamentary group (APPG) for birth trauma’s 80-page report should give ministers, NHS bosses and the midwives and obstetricians who deliver care serious pause 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 starved of oxygen at birth, and “life-changing injuries to women as the result of severe tearing”. How some mothers were mocked, shouted at, denied pain relief, not told what was going on during their labour, left alone in blood-stained sheets, with desperate bell calls for help going unanswered – all examples of “care that lacked compassion”. And how, in some cases, “these errors were covered up by hospitals who frustrated parents’ efforts to find answers”. It amounts to a shameful catalogue of negligence in the only area of NHS care where two lives – one still unborn – are on the line.
Given this record of poor care, it is easy to see why settling legal claims for medical negligence in childbirth cases now costs the NHS in England £1.1bn a year. As the Commons public accounts committee pointed out last week, that figure is “equivalent to an eye-watering one-third of the NHS’s total maternity and neonatal services budget”.
Maternity services have been one of the most problematic, inadequate and dangerous areas of NHS care for many years. Three major inquiries since 2015 into maternity scandals – at the Morecambe Bay, Shrewsbury and Telford and East Kent NHS trusts – have produced heart-rending testimonies and carefully considered, often recurring, recommendations for change.
A fourth is under way into claims that hundreds of babies and mothers were harmed by poor care at Nottingham University hospitals NHS trust. Nottinghamshire police have also launched a criminal investigation into concerns raised by what began as 700 – and is expected to reach 1,800 – families.
Each of those first three inquiries have led to a flurry of ideas to improve care, and ministerial and NHS pledges to implement them. But, as noted by Angela McConville, the chief executive of the parenting charity NCT, the APPG’s conclusions show that “we hear the same issues being repeatedly identified, including women not being listened to, delays in receiving care, poor communication, the absence of compassion and cultural competence, and the lack of continuity of care”. And that a raft of reports has yielded only “slow progress around birth-related trauma”.
So what more needs to happen to finally make maternity care safe? The APPG has laid out its own 12-point plan. It is designed to sweep away a “maternity system where poor care is all too frequently tolerated as normal and women are treated as an inconvenience” and usher in one “where poor care is the exception rather than the rule”. It is a necessarily ambitious goal.
The MPs acknowledge that maternity care is a “system in which overwork and understaffing [are] endemic”. However, many of their suggestions involve ending, somehow, the persistent and widespread shortages of staff, especially midwives, but also obstetricians, that – as the Care Quality Commission, Royal College of Midwives and Commons health select committee argue – make the safe, personalised and high-quality care that everyone wants all mothers to receive impossible to deliver in practice.
More midwives would be needed to implement the APPG’s suggestions: that fathers are kept informed during labour about how it is going; that women receive the continuity of care they prize so highly; that the stark racial inequalities in maternity outcomes are tackled; and that all NHS trusts offer antenatal classes. Staggeringly, though, while the NHS workforce in England has grown by 175,000 since the December 2019 general election, there are now 48 fewer midwives.
That raises serious doubt about the viability of the MPs’ first and most important recommendation: that a new national maternity improvement strategy, led by a maternity commissioner answerable to the prime minister, should outline ways to “recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services”. Unless that happens, it is hard to see meaningful improvements happening.
However, more staff are leaving than joining a vital area of care in which joy should be abundant, but pressures are great and inadequate care too common. That suggests that the APPG’s findings will not prove to be the watershed moment maternity services desperately need.
