Like previous inquiries on maternity care failings, the birth trauma report published on Monday was instigated by a campaigner with first-hand knowledge. After a 40-hour labour in which she suffered a third-degree tear to her perineum, followed by surgery without a general anaesthetic, Theo Clarke was horrified by the poor care she received on a ward. Last October, Ms Clarke, who is the Conservative MP for Stafford, led the first UK parliamentary debate about birth trauma. This week’s report marks the culmination of months of work by the all-party group she chairs.
Drawing on expert evidence as well as that of 1,300 people who wrote in about their own experiences, the report vividly conveys the human cost of past failures. One of Ms Clarke’s goals was to break the taboo surrounding birth trauma. Here are harrowing details of the physical and psychological consequences when labour goes wrong and care is inadequate. Birth trauma means overwhelming distress linked to childbirth with a negative impact on health. About 30,000 women each year (between 4% and 5% of all new mothers) are diagnosed with post-traumatic stress disorder. Risk factors include complications leading to delivery by emergency caesarean or using forceps, and prior mental health problems.
Most of the 600,000 births in England each year are not traumatic. Trauma is the exception, not the rule. But the MPs are right to say that it should be far rarer than it is. The focus on the specific issues faced by birth-injured women is important. Some people will be shocked to learn that childbirth can result in lifelong faecal incontinence. One senior doctor told the inquiry that one reason women aren’t warned is that they might ask for a caesarean delivery because they are scared.
Some findings echo those of earlier reports. These include problems around communication and consent, a lack of care and empathy from staff, poor record-keeping, a lack of transparency and accountability for mistakes, and significant racial and socioeconomic disparities – with black and Asian women having much worse outcomes, along with vulnerable groups including care-leavers.
Other issues include difficulty accessing treatment, especially after birth. The rivalry between doctors and midwives that has led to previous maternity care failures, for example at Morecambe Bay, does not feature strongly in this report. But practices embedded in NHS obstetric medicine, for example the continued use of forceps, are highlighted. These instruments are used in 7.5% of births in England, compared with 0.5% in Sweden and Austria.
Maria Caulfield, the women’s health minister, apologised on Monday to mothers who have been harmed. Amanda Pritchard, the head of NHS England, agrees that standards are “not good enough”. The backdrop against which improvement must now be attempted is extremely challenging. One expert’s evidence focused on the struggle to retain experienced midwives.
With the Care Quality Commission judging almost two-thirds of maternity units to be not safe enough, the need for a system-wide upgrade is obvious. This report’s recommendations would, if implemented, be a good way to start. Most important would be the adoption of a national minimum standard set out in a single document. This should include a new entitlement to improved postnatal checks – with the workforce to deliver it. At a time when thoughtful, cross-party policy initiatives are thin on the ground, this is a valuable piece of work.
