Will any woman who has given birth on the NHS be surprised by a damning report into maternity services? I wasn’t. I was horrified to read of babies born with cerebral palsy because of mistakes and failures made before and during labour. I was deeply saddened to read about mothers who were mocked, neglected, patronised, even shouted at, by midwives during childbirth, with many suffering long-lasting effects. But surprised? No.
Aspects of this Birth Trauma Inquiry are eerily familiar. In 2022, the Ockenden report into maternity services at Shrewsbury and Telford Hospital concluded that ‘repeated’ failures in care may have led to the deaths of more than 200 babies, and of nine mothers. But this wasn’t even the first: a Morecambe Bay inquiry in 2015 had investigated similar concerns and made similar discoveries. Now, the All-Party Parliamentary Group for Birth Trauma has drawn attention to many more births which have led to poor outcomes for mother or baby.
In childbirth, women are too often treated like conduits and ignored
A picture has emerged in recent years of inadequate maternity care and a fixation among certain staff with ‘normal’ deliveries. Women have been nudged towards giving birth in midwife-led units, with little evidence of joint decision-making or informed consent. There appears to be a bias against intervention that we would not expect in almost any other area of medicine: people with gaping wounds are not sent home from hospital and told to come back if they turn gangrenous.
What no one seemed to realise was that if we allowed this dogma to spread, an inevitable result would be to strip mothers of their agency. Today’s report, based on a call for evidence that elicited 1,300 responses, tells of women frequently feeling they were subjected to treatments they had not consented to, and many feeling they had not been given enough information to make informed decisions during labour.
In virtually every other aspect of motherhood, women are told to listen to their bodies and follow their intuition. In childbirth, however, they are too often treated like conduits and ignored. Many women told the APPG that they experienced signs of labour in their second trimester but were told that they were mistaken. One woman carrying twins, who went into premature labour at 19 weeks, was initially disbelieved. She lost both babies and, nearly two decades later, is still ‘traumatised’ by the experience.
When a friend voiced concern that hours of pushing might do irreparable damage to her pelvic floor and could she speak to a consultant, her midwife responded snappily: ‘Don’t worry about after, just think about today and getting this baby out’. In other words, forget the rest of your life, just focus on giving birth how we think best. Is it any wonder the APPG heard from women suffering pelvic organ prolapse, urinary incontinence or chronic pain?
It’s not just in the delivery room that mothers are being let down. In the UK, women are scanned just twice during their pregnancies – at 12 and 20 weeks – meaning that five months will typically pass without proper foetal monitoring. In Germany, there is an additional scan around 30 weeks of gestation. It’s the same in Belgium, the Netherlands and virtually any other developed nation. And then we wonder why our infant mortality rate is higher than most of Europe. In France, the government provides all women with la reeducation perineale – up to 20 sessions of therapy to restore the postnatal pelvic floor. Here, as the APPG points out, women don’t even get a proper check up.
The APPG’s co-chairs Theo Clarke and Rosie Duffield are to be commended on raising awareness, particularly over maternal injuries many will find embarrassing to discuss, but there is much more to be done. Why is it, for instance, that black women are almost four times as likely as white women to die during pregnancy? If we need more midwives and obstetricians, as they recommend, how will they be funded?
And we should consider how these scandals might affect young women’s attitudes towards motherhood. A UCL survey earlier this year found more than a third of teenagers in England don’t want to have children, with fears about pregnancy and childbirth among the reasons cited. Figures from the ONS have recently shown British women are having fewer children than at any point since at least 1939. If we want to tackle our baby bust, improving maternity services and giving people a more positive start to parenthood ought to be a priority.
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