In January 2024, the All-Party Parliamentary Group (APPG) on Birth Trauma established the first national inquiry to investigate the reasons for birth trauma and to develop policy recommendations to reduce instances of trauma during birth. It follows investigations into failings in maternity care at a number of specific Trusts. In fact, the CQC found half of maternity units in England were either ‘inadequate’ or ‘require improvement’.
Research shows that 4 to 5% of women develop PTSD every year after giving birth and that about one third of women experience birth as traumatic. This has significant social and economic consequences, from the cost of treatment and legal claims to women’s relationships with their partners and babies as well as damaging effects on their day-to-day lives.
Much of the testimony heard during the inquiry was harrowing and included ‘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 of these cases, the trauma was caused by mistakes and failures made both before and during labour. Frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers’. As clinical negligence practitioners, we are very familiar with these accounts.
Many of the stories told of care that lacked compassion. The overwhelming narrative was one of distress at ‘being neglected, ignored or belittled at a time when women were at their most vulnerable’. Again, sadly, this will not surprise many legal practitioners. A key theme highlighted in the report was a failure to listen to women and of them being told that they were being over-anxious. I am a strong advocate that patients (and often their families) know their own bodies best and any concerns raised should be given the upmost consideration.
Many patients who instruct Solicitors to act on their behalf following a traumatic birth still do not know fully what has happened to them. They are either given information at a time when they are unable to process it, in medical jargon or simply not given the information at all. This lack of communication and clarity is often one of the main reasons people come forward and engage with a solicitor.
The report deals with complaints and claims and states that many submissions described how the experience of birth trauma was made worse by a failure of hospitals to deal sensitively with complaints about poor care. Complaint responses can take a very long time to be prepared and, when they are, can often be poorly worded. Even if admissions are made, these are not binding and can later be denied within any subsequent claim. All of this leads to frustrations and anger.
Although there are several strategy documents relating to maternity services, there is no single overarching document. Sadly, it is often the case that, although lessons may be learnt by one hospital following an investigation/complaint/clinical negligence claim, this information is not shared throughout the whole NHS. The report suggests that maternity strategy should be brought into a single, living document, hosted on the Government website and continuously brought up-to-date. This is to be welcomed. It will allow both medical professionals and patients to know the standards that are required and what should be expected.
To allow this strategy to be produced, they suggest that a Maternity Commissioner should be put in place by the Government (and who will report to the Prime Minister) to look at:
Recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services and provide mandatory training on trauma-informed care.
Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.
Offer a separate 6-week check post-delivery with a GP for all mothers which includes separate questions for the mother’s physical and mental health to the baby.
Roll out and implement, underpinned by sufficient training, the OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce risk of injuries in childbirth.
Oversee the national rollout of standardised post birth services, such as Birth Reflections, to give all mothers a safe space to speak about their experiences in childbirth.
Ensure better education for women on birth choices. All NHS Trusts should offer antenatal classes. Risks should be discussed during both antenatal classes and at the 34-week antenatal check with a midwife to ensure informed consent.
Respect mothers' choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.
Provide support for fathers and ensure nominated birth partner is continuously informed and updated during labour and post-delivery.
Provide better continuity of care and digitise mother’s health records to improve communication between primary and secondary health care pathways. This should include the integration of different IT systems to ensure notes are always shared.
Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
Commit to tackling inequalities in maternity care amongst ethnic minorities, particularly Black and Asian women. To address this NHS England should provide funding to each NHS Trust to maintain a pool of appropriately trained interpreters with expertise in maternity and to train NHS staff to work with interpreters.
NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.
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