Birth trauma report – ending the postcode lottery

Posted: 14/05/2024

In response to concerns about the standard of maternity care in the UK and the impact this is having on the safety of mothers and their babies, the all-party parliamentary group (APPG) on birth trauma has this week published its report. 

In October last year, the Care Quality Commission ranked two-thirds of maternity units as ‘inadequate’ or ‘requires improvement’, the Maternity Safety Alliance (MSA) wrote to the health secretary requesting a statutory public inquiry into maternity safety, and Theo Clarke MP led the first ever debate on birth trauma in Parliament, talking openly and passionately about her own experience of childbirth. 

In January 2024, the birth trauma APPG set up the inquiry aimed at understanding why so many women experience traumatic birth and how the current state of maternity care can be improved. At that time, research showed ‘4-5% of women developed post-traumatic stress disorder (PTSD) after giving birth and as many as one in three found some aspects of their birth experience traumatic.’

The report ‘Listen to Mums: Ending the Postcode Lottery on Perinatal Care’ was published on 13 May 2024. The full document can be found here.

The report identifies key problems with maternity care, including mistakes and failures in care, both before and during labour, which led to ‘stillbirth, premature birth, babies born with cerebral palsy caused by oxygen deprivation and life changing injuries to women’. It is noted that ‘frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers’. There is also an acknowledgment that the statutory duty of candour, the duty to be open and transparent about care and to acknowledge when things have gone wrong, is not being applied effectively. 

Women reported a lack of compassion from midwives and doctors, and ‘frequently felt they were subjected to interventions they had not consented to and many felt they had not been given enough information to make decisions during birth’. The inquiry noted ‘harrowing’ stories of childbirth and confirmed that ‘some of the most devastating accounts came from women who had experienced birth injuries, causing a lifetime of pain and bowel incontinence’. There was an ‘almost-universal theme’ of poor quality post-natal care and ‘women from marginalised groups, particularly those from minoritised ethnic groups, appeared to experience particularly poor care, with some reporting direct and indirect racism’. 

The inquiry also considered the social and financial impact of birth trauma including difficulties bonding with the baby and pressure on family relationships, deciding not to have any more children, and being unable to return to work.  

Maternity professionals were also consulted and many reported that they were overworked and understaffed, and there was a harmful culture of bullying. They experienced high levels of stress and burnout, mental health related absences and many had considered leaving the profession. 

The birth trauma inquiry report makes recommendations for a more ‘woman-centred’ approach, where mothers are treated with compassion and respect, and ‘poor care is the exception rather than the rule’. To achieve this, the inquiry suggests that the UK government should publish one over-arching ‘National Maternity Improvement Strategy’, to be led by the new ‘Maternity Commissioner’, focusing on the following: 

1. Midwives - 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.
2. Specialist maternal mental health services - provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.
3. Separate six-week check for mothers - offer a separate six-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.
4. Training to reduce risk of maternal injuries - 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.
5. Improve post-birth services - 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.
6. Better education on birth choices - 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.
7. Respect and compassion - respect mothers' choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.
8. Support for fathers - provide support for fathers and ensure the nominated birth partner is continuously informed and updated during labour and post-delivery.
9. Continuity of care and sharing of information - provide better continuity of care and digitise mothers’ 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.
10. Extend time limit for childbirth clinical negligence claims - extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
11. Tackle inequalities - commit to tackling inequalities in maternity care among 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.
12. Consider economic impact of birth trauma - NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.

Sarah Hibberd, an associate in Penningtons Manches Cooper’s clinical negligence team specialising in maternity care and birth injuries, comments: “Whilst birth can sometimes be difficult even with excellent care, it is evident that underperforming maternity services are contributing to the difficulties women face, and a substantial proportion of women are having traumatic birth experiences.  

“As a clinical negligence solicitor, I work with families who have experienced substandard care during pregnancy, labour or delivery, causing injuries to mother and baby, and sometimes even leading to death. It is unbelievably frustrating to see repeated patterns of poor care and mistakes being covered up. To ensure safer care, it is imperative that maternity services are honest about their failures and learn from mistakes by implementing training and better procedures.  For the sake of all mothers and babies, I hope the government heeds the recommendations in the report and uses the £35 million pledged in the Spring Budget to work towards improving maternity care.   

‘The limitation date for issuing court proceedings in a clinical negligence claim is usually three years from the date of negligent treatment (for adult claimants). It is therefore interesting to see the suggestion that, for clinical negligence claims relating to childbirth, the time limit should be extended to five years. I fully support this proposal because, understandably, families are often traumatised by negligent treatment and are busy dealing with the practicalities of arranging medical care to address the injuries they have suffered, dealing with the struggles of daily life living with physical and/or psychological injuries, caring for a baby who has suffered a brain injury, or grieving a mother or baby who have not survived. At times like this, considering a clinical negligence claim and speaking to solicitors might not be at the forefront of their mind so, by allowing some extra time, it gives people breathing space to consider their options.  If this proposal is accepted, it will be interesting to see whether it is also considered for other types of clinical negligence claim.”

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