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

<span>‘It is not only austerity, but also a need for greater empathy, understanding and responsiveness, or, to put it simply, listening to the mother.’</span><span>Photograph: Science Photo Library/Ian Hooton/Getty</span>
‘It is not only austerity, but also a need for greater empathy, understanding and responsiveness, or, to put it simply, listening to the mother.’Photograph: Science Photo Library/Ian Hooton/Getty

The maternity trauma report is deja vu all over again (Women having ‘harrowing’ births as hospitals hide failures, says MPs’ report, 13 May). I cannot read about it because it makes me want to scream.

I was around for the Shrewsbury and Telford hospital trust report a couple of years ago. All those dead babies, all those mothers and parents talking about not being listened to or respected. All that handwringing from service providers, all those promises from politicians. The recommendations were set up 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, 13 May). For instance, continuity of midwifery care through the maternal pathway prevents so much of the stuff we read about now.

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

I say to parliament and the royal colleges – quit the crocodile tears and handwringing, and act now. The solutions are there in the Better Births report, the Kirkup report on East Kent hospitals, and go right back to the 1992 Winterton report by 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 abusive partner promising not to do it again – a promise that is never kept.
Ruth Weston
Llanfyllin, Powys

• While austerity clearly exacerbates the situation, it is not the only cause (The birth trauma scandal is not about one bad apple, one bad culture or one bad area – it’s about the mess of austerity, 13 May). I can still recall every detail of a traumatic childbirth in 1990, when a midwife kept popping in to berate me for being weak and telling me to pull myself together and cope with the pain. By the time I gave birth I was too weak and exhausted to even think about my baby. I needed a 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 the physical impacts of the treatment I received (or didn’t). So I am forced to conclude that it is not only austerity, but also a need for greater empathy, understanding and responsiveness, or, to put it simply, listening to the mother, rather than treating her as another in a factory line of cases seen every day.
Name and address supplied

• I had a very mixed experience of maternity care at a London teaching hospital (St Thomas’s) in 1986, long before austerity. I had a very difficult birth requiring forceps and I was overwhelmingly grateful to the obstetrician for delivering my son undamaged. But all the details of mockery for requesting pain relief, bullying and intimidation are familiar. I remember being shouted at for lying in blood‑soaked sheets after the birth and being shouted at to change the sheets myself. I then had a two-day wait for antibiotics for a hospital-acquired infection. I was too ill to breastfeed and we had to stay in that appalling ward for nearly two weeks until my family came to my rescue.

Austerity is not the only reason. There is something else there too: something to do with vulnerability and dependency that invites care from some but cruelty from others. Thirty-five years later, and my son and daughter-in-law had a very good maternity care experience.
Julia Davies
Burton, Dorset

• The culture in which mothers are not listened to, resources are thinly stretched, and birth trauma proliferates did not start in 2010. In 2008, at 29 weeks pregnant with my first child, I spent a very lonely night in severe pain on the antenatal ward, having been admitted as a precaution due to abdominal cramps. Wandering the ward trying to get help, I was told “if I was in labour I wouldn’t be walking around”. At around 5am I concluded that either I was in labour or I was about to die. Eventually someone came to see what the matter was. My son was born less than an hour later, over 10 weeks early.

I know many mothers who gave birth around that time who felt trivialised and violated by their birthing experiences. Funding is vital, but it’s not just about money: we desperately need a culture change. Mothers must be treated with dignity and compassion, not belittled or treated as a mere 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 just made things worse.
Camilla Hamilton
Letchworth, Hertfordshire

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

The NHS is now moving towards personalised maternity care. In theory, women are now informed about care options (with the risks and benefits of each) and make their own decisions. But the time and cost taken to deliver this is huge. Maternity staff have always needed to know recommended best practices. But they now need to also be able to explain to women the evidence behind both best practice and the other options that are not recommended. Every decision needs to be justified, explained and typed out in detail.

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

Personalised care is ideal, but costly in time and resources. Using the aeroplane analogy again, if flight attendants had to discuss with each passenger a choice of safety features based on evidence (“how much are my chances of death increased if I choose to be in the toilet for take-off?”), it is clear that flight attendants would need to increase in number and change their training.

Everyone agrees that maternity care needs to be improved. Unfortunately, many of the well‑meaning attempts to improve maternity care – particularly personalised care and electronic notes – have not been accompanied by the necessary increases in staff numbers. Add to this the rising scrutiny, public “maternity scandals” and litigation, and it is no wonder that there are record levels of stress and staff leaving. This creates a vicious circle where those remaining are stressed, busy and not in the best frame of mind to provide the care that they want to.

It is only with major increases in staff numbers that we will be able to provide the quality of care that we want to, and that women deserve.
Prof Andrew Weeks
Consultant obstetrician, Liverpool Women’s Hospital; Professor of international maternal health, Department of Women’s and Children’s Health, University of Liverpool

• I am a midwife of 14 years and couldn’t agree more that austerity is the problem. A labour ward is an amazing place to work. The majority of midwives and obstetricians are – I hope – kind and compassionate; they had a calling and they want to be there. But lack of funding and staffing will let us down every time. It’s important that these things are examined, and the report is welcome and necessary. However, you can perform as many investigations and write as many policies as you like; the recovery of maternity services will only be possible if you recruit more midwives and employ more per trust. Pay them to train, don’t make them pay. Double the number of midwives on the wards.
Amelia Evans

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