Listen To Mums: Ending The Postcode Lottery On Perinatal Care – A Report By The All-Party Parliamentary Group On Birth Trauma

The report from the All-Party Parliamentary Group (APPG) on Birth Trauma was published yesterday, following a call for evidence from persons affected by a difficult birth experience and from experts in the field.

The APPG for Birth Trauma was chaired by Theo Clarke MP (Member of Parliament for Stafford), who set up the APPG following the difficult birth of her daughter and the public response to a speech she made about her experience in the House of Commons. The Group includes a diverse range of MPs with an interest in the issues surrounding birth trauma and baby loss.

The report itself sets out the reason for the inquiry in the introduction:

Why an inquiry into birth trauma? While many women in the UK have a positive experience of birth, resulting in a healthy baby, this is not always the case, and this inquiry has focused on the times when birth has been traumatic, leading to poor outcomes for the mother or baby. In the past 10 years, there have been three major investigations into failings in maternity care at specific NHS trusts: Morecambe Bay, Shrewsbury and Telford, and East Kent. A fourth is underway at Nottingham University Hospitals. These reports all led to recommendations to improve maternity care, but a current programme of inspections by the Care Quality Commission (CQC) has resulted in nearly half of maternity units in England being rated as either “inadequate” or “requires improvement”. Current policy on improving maternity care is fragmented. Although there are several national policy documents that address the need to improve maternity care, the inquiry heard that there is no single overarching strategy document. Donna Ockenden, who is chairing the inquiry into maternity care failings in Nottingham, told the inquiry: “Leaders across maternity services report continuous requests for information from multiple bodies responsible for ‘oversight’ of maternity care in the UK. Frequently the requests are duplicated or only very slightly different showing that there is ineffective coordination between these multiple bodies. This is not efficient and wastes time. The system of maternity service oversight must be streamlined & this made more effective.”

The executive summary calls on the UK government to address the issues raised by the inquiry:

Our key conclusion has been on the need to introduce a base standard in maternity services across the United Kingdom. Currently there are several strategy documents relating to maternity but no single overarching document. We believe that maternity strategy should be brought into a single, living document, hosted on the UK government website and continuously brought up-to-date.

To this end, the All-Party Parliamentary Group on Birth Trauma calls on the UK Government to publish a National Maternity Improvement Strategy, led by a new Maternity Commissioner who will report to the Prime Minister, which will outline ways to:

1. 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. Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.
3. 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.
4. 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. 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. 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 mothers’ choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.
8. Provide support for fathers and ensure nominated birth partner is continuously informed and updated during labour and post-delivery.
9. 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.
10. Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
11. 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. NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.

Summarising findings the report submits that the picture to emerge was of a maternity system where poor care is all-too-frequently tolerated as normal, and women are treated as an inconvenience. We have made a set of recommendations that aim to address these problems and work towards a maternity system that is woman-centred and where poor care is the exception rather than the rule.

The report was welcomed by the Health and Social Care Secretary, Victoria Atkins, in the House of Commons yesterday who accepted that, whilst many people have a good experience, there is too much ‘unacceptable variation’, and as this report starkly highlights the adverse effects of unacceptable care care are profound. She referred to plans already underway to address some of the issue raised, and acknowledged that there is still much to do. As she put it, ‘So watch this space’.

If you have experienced birth trauma and would like to ask for legal advice please do not hesitate to contact our birth injury experts on 0330 822 3451 or request a callback.