BMJ, by Clare Dyer, 14 May 2024
The first ever parliamentary inquiry into birth trauma in the UK has found “shockingly poor quality” of care in a maternity system where overwork and understaffing are “endemic.” The inquiry by the All Party Parliamentary Group on Birth Trauma heard “harrowing accounts of stillbirth, premature birth, babies born with cerebral palsy caused by oxygen deprivation, and life-changing injuries to women as the result of severe tearing.” In many cases, the inquiry concluded, the “trauma was caused by mistakes and failure made before and after labour. Frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers.”
The group, chaired by the Conservative MP Theo Clarke and co-chaired by the Labour MP Rosie Duffield, received more than 1,300 submissions to its inquiry from parents who experienced traumatic births and nearly 100 submissions from maternity professionals, including obstetricians and midwives. It has called on the UK government to draw up a national maternity improvement strategy, led by a new maternity commissioner reporting to the prime minister. The commissioner would oversee the implementation of 12 recommendations, including recruiting, training, and retaining more midwives, obstetricians, and anaesthetists to ensure safe levels of staffing and provide mandatory training on trauma-informed care.
Other recommendations include universal access to specialist maternal mental health services to end the postcode lottery; better education for women on birth choices and a respect for mothers’ choices about giving birth and access to pain relief; and the rollout of the obstetric and anal injury sphincter (OASI) care bundle to all hospital trusts to reduce risk of injuries in childbirth.
Key themes emerging from the inquiry included a failure to listen to women, a lack of informed consent, poor communication, lack of pain relief, lack of kindness, breastfeeding problems, and a failure to deal sensitively with complaints. Birth notes were “often falsified or lost.” Some women were given diagnoses of post-traumatic stress disorder as a result of their experiences.
The inquiry heard accounts of “women not being listened to when they felt something was wrong, being mocked or shouted at, and being denied basic needs such as pain relief. Women frequently felt they were subjected to interventions they had not consented to, and many felt they had not been given enough information to make decisions during birth. The poor quality of postnatal care was an almost universal theme.”
The report said, “Women shared stories of being left in blood stained sheets, or of ringing the bell for help but no one coming. Some of the most devastating accounts came from women who had experienced birth injuries, causing a lifetime of pain and bowel incontinence.”
One woman who was in extreme pain for the final few weeks of her pregnancy was labelled an “anxious mother” in her notes. In fact she was bleeding internally from spontaneous hemoperitoneum, a rare and often fatal complication of pregnancy. Several women “had stories of being left to lie in their own blood, urine, or excrement, or even berated by midwives for having soiled themselves.”
Another woman had her fourth degree tear mis-diagnosed by a midwife as a second degree tear and repaired accordingly. Her later bowel incontinence was wrongly diagnosed as irritable bowel syndrome. Over 21 years she had 18 surgical procedures, the last a colostomy in 2019. Women spoke of daily episodes of bladder and bowel incontinence, affecting their ability to work.
An OASI care bundle has been piloted successfully in the UK, causing rates to fall. But the inquiry noted that the bundle had not been implemented in all maternity units, partly because it had not been recommended by the National Institute for Health and Care Excellence.
In the past 10 years there have been major investigations into failings in maternity care at three NHS trusts: Morecambe Bay, Shrewsbury and Telford, and East Kent. A fourth is under way at Nottingham University Hospitals. The current Care Quality Commission maternity inspection programme has so far rated nearly half of England’s maternity units as either “inadequate” or “requires improvement.”