A bad week for maternity services
Neil Stewart, Editorial Director, Maternity and Midwifery Forum | MATFLIX
There has been a lot going on for UK Maternity services, though you may not have been aware of the news with all going on in the Middle East, the Ukraine and the weather! Neil Stewart, Editorial Director for the Maternity and Midwifery Forum, presents and reflects on a very difficult week.
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It is hard to think of a week, 12 – 20 October 2023, that has been worse for the reporting of maternity services.
The headlines may have been bigger when Donna Ockenden reported on the outcome of her review into Shrewsbury and Telford or previous inquiries into East Kent or Morecambe Bay.
The terrible news from the Middle East has, however, obscured a series of reports and events that, cumulatively, for maternity and midwifery services, must be one of the worst for the standing of the NHS maternity service.
Three events in 8 days paint a picture of a service under stress, going backwards, losing women’s trust and finally judged “inadequate” in a majority of maternity services.
“Maternal mortality has increased by 15% since 2009-11”
First there was the latest MBRRACE-UK Report 2023
“The Government’s ambition in England was to reduce maternal mortality by 50% between 2010-2025. This target is unlikely to be met. Since 2009-11, maternal mortality has increased by 15%.
Deaths from direct causes (such as childbirth-related infections or suicide) have increased.
For conditions such as pre-eclampsia, the rates remain more than five times higher than the lowest rate in 2012-14.
Women from Black ethnic backgrounds remain four times more likely to die, and women from Asian ethnic backgrounds are twice as likely to die, compared to White women.
Suicide is the leading direct cause of death between 6 weeks and 12 months after the end of pregnancy.
Women living in the most deprived areas continue to have the highest maternal mortality rate compared to those living in the least deprived areas.
Twelve percent of women who died during or up to a year after pregnancy in the UK in 2019-21 had multiple severe disadvantages.”
Postnatal care
“Over 300 women died in the 12 months after pregnancy. The focus of maternity care needs to extend beyond pregnancy and childbirth. Postnatal care is an important window of opportunity, yet services are currently not joined up; the focus on the mother’s health often falls away and women lack the support they need. This report highlights the importance of improved multi-disciplinary and multi-agency working to include GPs, health visitors, domestic abuse and substance misuse services, mental and public health teams and social care.”
These quotes above speak for themselves.
“These results are shocking” – Theo Clarke, MP
Second came a debate on Birth Trauma in the House of Commons on Thursday 19th October, tabled by Theo Clarke, the Conservative MP for Stafford.
In her introduction she said:
“I spent over two hours awake without a general anaesthetic, I could hear them talking about me, and obviously it was not looking good. It was the most terrifying experience of my life.
I remember being wheeled into the recovery ward after surgery, where I encountered a nurse who had not read her notes and assumed that I had had a C-section. I was then moved to a side room, where I was hooked up to a catheter and a drip and was lying in bed next to my baby, who was screaming in her cot. I could not pick her up. I pressed the call button for help and a lady came in and said, “Not my baby; not my problem,” and left me there.
I partnered with Mumsnet—the online forum for mothers—to conduct a national birth trauma survey, given the lack of data. Our survey received 1,042 responses. The key results showed that 53% experienced physical trauma; 71% experienced psychological or emotional trauma; 72% said that it took more than a year to resolve; 84% who experienced tears said that they did not receive information about birth injuries ahead of time; and 32% experienced notes not being passed on between shifts. These results are shocking,..
Today I call on the Government to add birth trauma to the women’s health strategy; recruit more midwives; ensure perinatal mental health services are available across the UK; provide appropriate and mandatory training for midwives with a focus on both mental and physical health; ensure that the post-natal six-week check with their GP is provided to all mothers and will include separate questions on both the mother’s physical health and her mental health in relation to the baby; improve our continuity of care so there is better communication between secondary and primary health care, including explicit pathways for women in need of support; provide post-birth services nationally, such as birth reflections, to give mothers a safe space to speak about their experiences in childbirth; roll out the obstetric anal sphincter injury care bundle to all hospital trusts in England to reduce the risk of injuries in childbirth; provide better support for partners and fathers; and, finally, have better education for women on their birth choices and on risks in order to ensure informed consent.”
It is a list of reform that most in midwifery and maternity services would support. Yet, many localities would report that these services are a long way from available and many are squeezed out by lack of midwives, lack of time and pressure on the service. It is worth remembering that one of the consequences of Ockenden was an attempt in many localities to put a pause on “continuity of care” which women see as the key to better and safer care.
“65% of maternity services are rated “inadequate”
Third came the newspaper reports that the CQC report on Friday 20th found that 65% of maternity services were rated “inadequate”.
But that is not what the actual report says, it reflects the tendency to believe the worst of maternity services in the current media narrative.
The actual reported figures are below.
