Maternity services are failing mothers and babies, and it’s not just down to austerity | Women’s health

The maternity trauma report is déjà vu all over again (Women giving ‘excruciating’ births as hospitals cover up failures, says MPs report on 13 May). I can’t read about it because it makes me scream.

I was around for Shrewsbury and Telford Hospital Trust Report A few years ago. All those dead babies, all those mothers and parents speaking out about not being heard or respected. All those manipulations by service providers, all those promises by politicians. The recommendations were created to prevent the experiences we heard about this week (‘I was left lying on the ground in pain’: shocking stories from UK birth trauma inquiry May 13). For example, continuity of midwifery care through the maternal pathway prevents so many of the things we read about now.

A midwife you know and trust and who knows and respects you – this should not be a pipe dream, it should be an evidence-based, fully funded intervention to ensure the well-being of mother and baby.

I say to Parliament and the Royal Colleges – stop the crocodile tears and hand-wringing and act now. The solutions are there in Better births report, of Kirkup Report for East Kent hospitals and go straight back to the 1992 Winterton Report to the Commons Health Committee. Force the NHS to make them happen. Fund them to make them happen. Until then, I just hear the voice of an abuser promising never to do it again—a promise never kept.
Ruth Weston
Llanfyllin, Powys

Although austerity clearly exacerbates the situation, it is not the only cause (The birth trauma scandal isn’t about one bad apple, one bad crop or one bad area – it’s about the austerity mess May 13). I can still remember every detail of a traumatic birth in 1990 when a midwife kept coming in to berate me for being weak and tell me to brace myself and deal with the pain. By the time I gave birth, I was too weak and exhausted to even think about my baby. I needed a blood transfusion as a result of the traumatic “natural” birth. It took many weeks to bond properly with my child.

I chose not to have another child and I still suffer from the physical effects of the treatment I did (or didn’t) receive. So I’m forced to conclude that it’s not just austerity, but a need for more empathy, understanding and responsiveness, or, to put it more simply, listening to the mother instead of treating her as just another one of the factory cases observed every day.
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I had a very mixed experience of maternity care in a London teaching hospital (St Thomas’s) in 1986, long before austerity. I had a very difficult labor requiring forceps and was extremely grateful to the OB/GYN for delivering my son unharmed. But all the details of the mockery of asking for pain relief, the harassment and the intimidation are familiar. I remember being yelled at for laying in bloody sheets after giving birth and being yelled at to change the sheets myself. Then I had a two day wait for antibiotics for a hospital acquired infection. I was too sick to nurse and we had to stay in that horrible ward for almost two weeks until my family came to rescue me.

Austerity is not the only reason. There’s something else there, too: something about vulnerability and dependency that invites care from some but cruelty from others. Thirty-five years later, my son and daughter-in-law have had a very good experience of motherhood.
Julia Davis
Burton, Dorset

The culture where mothers are not listened to, resources are stretched thin, and birth trauma proliferates did not begin in 2010. In 2008, at 29 weeks pregnant with my first child, I spent a very lonely night in severe pain in the antenatal ward, having been admitted as a preventive measure due to abdominal cramps. As I wandered around the ward trying to get help I was told “if I was in labor I wouldn’t be walking around”. Around 5 am I concluded that I was either in labor or about to die. Eventually someone came to see what it was. My son was born less than an hour later, more than 10 weeks early.

I know many mothers who gave birth at this time who felt belittled and abused by their birth experiences. Funding is vital, but it’s not just about money: we desperately need a culture change. Mothers should be treated with dignity and compassion, not belittled or treated simply as a baby vessel.

The life-changing injuries and PTSD described in the Birth Trauma Report are just the tip of the iceberg of a system in which the physical and emotional neglect of mothers has been routine for years. Covid and austerity only made things worse.
Camilla Hamilton
Letchworth, Hertfordshire

A shortage of maternity staff is directly or indirectly behind many of the problems identified in the birth trauma report. But how is this possible when the number of midwives in the UK has been increasing for years? It’s true that pregnant women have become more medically complex and that the amount of care we can provide has increased significantly – but the problem is broader than that. Until 20 years ago, maternity in the UK was largely managed like any other hospital service: NHS decide what optimal care should be for a woman and then provide it. It’s as if you were a passenger on a flight – after boarding, you simply followed the safety instructions without question.

The NHS is now moving towards personalized maternity care. In theory, women are already informed about care options (with the risks and benefits of each) and make their own decisions. But the time and expense required to achieve this is enormous. Maternity staff should always be aware of recommended best practices. But now they also need to be able to explain to women the evidence behind the best practices and the other options that are not recommended. Every decision must be reasoned, explained and written in detail.

Staff should also be experienced in managing women who do not want to follow recommended best practice but choose alternative routes. And so the need for detailed notes and care for the elderly is even greater given the current levels of litigation.

Personalized care is ideal, but expensive in terms of time and resources. Using the airplane analogy again, if flight attendants were to discuss with each passenger an evidence-based choice of safety features (“how much does my chance of death increase if I choose to be in the take-off toilet?”), it is clear that flight attendants will have to increase their numbers and change their training.

Everyone agrees that motherhood needs to improve. Unfortunately, many of the well-intentioned attempts to improve maternity care—particularly personalized care and electronic notes—have not been accompanied by the necessary increases in staffing. Add to that increasing scrutiny, public ‘maternity scandals’ and litigation and it’s no wonder there are record levels of stress and staff turnover. This creates a vicious cycle where others are stressed, busy and not in the best mood to provide the care they desire.

Only by significantly increasing the number of staff will we be able to provide the quality of care that we want and that women deserve.
Prof. Andrew Weeks
Consultant Obstetrician, Liverpool Women’s Hospital; Professor of International Maternal Health, Department of Women and Children HelloUniversity of Liverpool

I’ve been a midwife for 14 years and I can’t agree more that austerity is the problem. The Labor Department is an amazing place to work. Most midwives and OB-GYNs are – I hope – kind and compassionate; they had a calling and they want to be there. But the lack of funding and staff will let us down every time. It is important that these things are addressed and the report is welcome and necessary. However, you can conduct as many investigations and write as many policies as you like; the recovery of maternity services will only be possible if you hire more midwives and hire more trusts. Pay them to train, don’t make them pay. Double the number of midwives on the wards.
Amelia Evans
London