No evidence and little research – it’s no wonder that women and babies continue to die

 A series of fatal failings in maternity care is evidence of a systemic problem within the NHS

Giving birth used to be one of the most dangerous things a woman could do. In parts of 15th-century Europe, women wrote wills as soon as they knew they were pregnant. In the 17th and 18th centuries, around one in 25 women died in childbirth. It was a danger that cut right across class, from queens to domestic servants, and one that women had to face over and over again. For their babies, the risks were even higher.

It is a miracle of modern medicine that the joy of getting pregnant no longer has to be tempered with the very real prospect that you or your baby may not survive the birth. A true marker of human progress is the fact that maternal and infant mortality have dropped dramatically in the UK even as births have become more complicated, with babies getting bigger and women having children later.

But in recent years, horror stories have emerged of women and babies suffering dreadful maternity care in a number of NHS trusts. Bereaved parents and spouses have fought to be heard in the face of a culture of cover-up and medical professionals blaming mothers for the deaths of their babies. First, there was the inquiry into baby deaths at Morecambe Bay foundation trust, which came about as a result of the tireless campaigning of James Titcombe, whose baby died in its care. It found a “lethal mix” of failings caused the avoidable deaths of at least 11 babies and one mother. Last year, an interim report was published into baby and mother deaths at Shrewsbury and Telford; covering more than 1,800 cases over 20 years, it is one of the biggest ever NHS scandals.

Some midwives and institutions have pursued an ideology of ‘normal birth’ at ‘pretty much any cost’. Photograph: UK Stock Images Ltd/Alamy

It described how babies and mothers needlessly died or were left with profound disabilities as a result of terrible care; babies suffered fatal skull fractures as they were forced out using forceps, and women were left screaming in agony for hours as medics belittled their pain and told them they were “lazy”. An inquiry is currently underway into baby deaths at East Kent, and last week the Independent reported that dozens of babies had died or been left brain-damaged at Nottingham University Hospitals NHS Trust.

The vast majority of mothers and babies will experience good maternity care in the UK. But this crop of scandals shows there is a systemic problem with the quality of NHS maternity care, with too many mothers and babies losing their lives as a result. More than 1,000 babies die or are left with severe injury each year as a result of something going wrong during labour. It goes beyond the current crisis of underfunding: the Care Quality Commission has found that four in 10 maternity services require improvement or are inadequate. Women of colour are disproportionately affected: black women are four times more likely to die in pregnancy or childbirth than white women.

When it comes to childbirth, this predisposition to disbelieve women in pain has been particularly toxic

There are two deep-seated cultural factors that are holding back maternity care. First, it has become increasingly well documented that women are disproportionately disbelieved when they say they are in pain, because there is a perception that we are oversensitive to pain, or exaggerate it. This is undoubtedly a factor in poor-quality healthcare for women.

Second, women’s healthcare is under-researched and under-evidenced. This is true of conditions that affect both men and women – diagnosis and care for women who suffer strokes and heart attacks is poorer because the research has predominantly focused on men – as well as things only women experience, like the debilitating pain of endometriosis. Research out last week showed that women are continuing to struggle to access treatment for the menopause: only 37% of women seeking help were given HRT despite Nice guidelines stating that the majority of women can benefit from it.

When it comes to childbirth, this predisposition to disbelieve women in pain and to underemphasise their medical needs has been particularly toxic, allowing an ideology to take hold that so-called normal non-medicalised birth is best, regardless of what a woman herself thinks or feels. Until just a few years ago, this was widely embraced by the establishment: a working group including the National Childbirth Trust, the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists, advocated for “normal birth” without medical interventions such as an epidural or caesarian section.

This has certainly been a factor in women and babies being denied life-saving care: at Morecambe Bay, midwives pursued non-medical births “at any cost”, bullying those doctors who tried to intervene. At Shrewsbury and Telford, there was a multi-professional focus on “normal birth” at “pretty much any cost”.

The best kind of birth is obviously a birth that delivers a baby safely, leaving a mother unharmed. For plenty of women, that will involve an epidural or a caesarian section. Terms like “normal birth” are stigmatising and shaming.

But while the RCM formally dropped this language in 2017, it lives on strongly in some parts of the midwifery profession. There are still midwifery conferences that promote “normal birth”. The University of Central Lancashire – a major midwifery training centre – still runs a course on “normal birth”. And a former president of the RCM last year submitted evidence to a select committee that stated women were not afforded the luxury dogs and cats have to “go off somewhere quiet and just get on with the process”, and argued for reduced obstetrician levels in labour wards.

Failures in maternity care are not just about understaffing and underfunding: they are linked to a deep-rooted societal perception that women are not to be trusted with their own bodies or to be allowed to make their own informed choices about birth. How much more evidence do we need that institutionalised sexism at the heart of our healthcare system has cost women and babies their lives?

(Source: The Guardian)