Good maternity care “is the exception rather than the rule” in England, according to today’s report from the all-party parliamentary group (APPG) on birth trauma. For the millions of women who have given birth over the past decade and more, this will come as little surprise.
When I wrote about my own traumatic birth in a cover story for the New Statesman last month, I was overwhelmed with the responses I received. Strangers – and close friends – were exceptionally kind to me. But I was overwhelmed, too, to learn how many women had received such poor treatment: some had suffered the worst fate imaginable – their babies had died or experienced life-changing harm; others, like me, had suffered appalling birth injuries, and weren’t fortunate enough to have been repaired properly; many were met with basic cruelty.
The report finds a “maternity system where poor care is all-too-frequently tolerated as normal, and women are treated as an inconvenience”. It presents a harrowing picture of a culture that leaves mothers in “blood-stained sheets”, and treats them – as one woman Rachael McGrath explained – like “a birthing vessel” or a “slab of meat”. After delivering her twins by Caesarean section, McGrath described the complete disintegration of her scar. “Nobody treated the fact that my insides were now on the outside,” she said. When Emily Barley’s baby died she explained how she was left without any care for more than half an hour: “Where has everyone gone? Where are they?” she recalled asking herself. The report also details the many women left incontinent by untreated serious tears.
Every year, about 25,000-30,000 women who give birth – approximately 4 per cent – are so distressed that they meet the diagnostic criteria for post-traumatic stress disorder. Far more experience their birth as traumatic, but don’t meet the high bar for an official diagnosis of PTSD. Given this major health crisis, it is remarkable that today’s report is the first of its kind. Every politician, doctor and midwife should have to read this document.
And this is not just a story of women treated with profound personal cruelty. It’s an economic problem too: traumatic births are costing the country billions. According to NHS Resolution – the arm of the Department of Health and Social Care that handles litigation – 62 per cent of the £6.6bn total clinical negligence cost of harm in 2022-23 was related to maternity. Of the £2.6bn spent on clinical negligence payments that year, £1.1bn (41 per cent) related to maternity. NHS England currently spends around £3bn a year on maternity and neonatal services.
Theo Clarke and Rosie Duffield, the APPG’s co-chairs, have provided 12 recommendations to mend this broken system. They include the recruitment and retention of more midwives, obstetricians and anaesthetists; improved access to maternal mental health services; the rollout and implementation of an OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce risk of serious injuries in childbirth; and for all NHS trusts to offer antenatal classes, which provide proper information of the risks of childbirth. Clarke and Duffield have called for further research into the economic impacts of traumatic birth, too.
All of these recommendations are underpinned by a call for the government to publish a national maternity improvement strategy, led by a new maternity commissioner who will report to the prime minister.
While some of the APPG’s suggestions will require investment, it’s striking how so many of the problems identified wouldn’t cost a penny to rectify. The group recognised that many women’s experiences showed a basic failure by staff to listen to their patients; failure to obtain informed consent from mothers (things were simply being done to them); a refusal to provide pain relief; a general lack of kindness. Better-staffed units would ease pressure on over-stretched midwives and obstetricians. But just as much could be improved by a dramatic shift in the institutional culture and attitudes to women.
This inquiry – long overdue – was “in its simplest form, an attempt to break this taboo and share the stories and experiences of mothers and fathers publicly and start a public discussion on the realities of giving birth”. Heaven knows it is needed. With discussion of the topic now taking place across the national media, and in parliament, hopefully this silent scandal will now be taken seriously. It’s the least that women, their partners, and their babies, deserve.
[See also: The strange history of the pill]
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