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Written on 14th May 2024 by Susan Brown

The All-Party Parliamentary Group on Birth Trauma has published the findings of its inquiry into birth trauma experienced by women during maternity and postnatal care in the UK. The report, Listen to Mums: Ending the Postcode Lottery on Perinatal Care, describes the harrowing experiences of physical and resulting psychological injury suffered by women as a result of mistakes, cover ups and neglect during childbirth, and aims to remove the taboo around discussing maternal birth trauma which has perpetuated and normalised the NHS’s toxic maternity culture.

The Birth Trauma Inquiry highlights that despite inquiry recommendations over the last ten years from maternity scandals at Morecambe Bay, Shrewsbury and Telford, and East Kent, and the ongoing investigation into care failures at Nottingham University Hospitals, nearly half of all maternity units in England are currently rated as either “inadequate” or “requires improvement” by the Care Quality Commission (CQC).

The All-Party Parliamentary Group on Birth Trauma has called on the government to introduce a baseline standard for maternity services in the UK, published in a single National Maternity Improvement Strategy, led by a new Maternity Commissioner who will be directly accountable to the Prime Minister.

 

What is birth trauma?

In medical negligence claims, birth trauma usually describes physical injuries, such as severe vaginal/perineal tears, that are suffered by the mother during childbirth. In its broader sense, however, birth trauma refers to the woman or birthing person’s emotionally and psychologically traumatic experience of childbirth-related events and interactions which can also have severe and life-changing negative effects on their health, relationships, work, daily activities and well-being.

According to the Birth Trauma Inquiry, research evidence shows that 4-5% (approx. 30,000) of women develop post-traumatic stress disorder (PTSD) every year after giving birth in the UK, and around a third of women experience birth as traumatic.

 

What is the Birth Trauma Inquiry?

The first national inquiry in Parliament was established in January 2024 by the All-Party Parliamentary Group (APPG) on Birth Trauma to investigate the reasons why so many women experience birth trauma during their maternity care and to help develop policy to reduce the rate of birth trauma. The inquiry was chaired by Theo Clarke MP, who set up the APPG for Birth Trauma following her own traumatic birth experience. The report was written by Dr Kim Thomas who is also CEO of the Birth Trauma Association, with input from a Special Advisory Group of maternity campaigners including the Birth Trauma Association and MASIC.

The inquiry received 1,311 personal stories from parents and 92 submissions from maternity-related professional organisations, charities and individuals such as midwives and obstetricians, as well as hearing testimony from parents and experts, including maternity professionals and academics.

The mothers who shared their stories had suffered stillbirth, premature birth, babies born with cerebral palsy caused by oxygen deprivation, and life-changing injuries from severe tears.  Of those mothers, 694 had given birth by (usually emergency) caesarean section and 378 had given birth by forceps. Their own physical injuries had included third-degree (106) and fourth-degree (41) vaginal/perineal tears. In 247 cases, their babies had spent time in neonatal intensive care or special care. For many, their birth trauma had led to a lifetime of pain and bowel incontinence, feelings of lack of self-worth, difficulties with bonding with their baby, relationship stress with partners, family and friends, and an inability to return to work. Where the babies had suffered a brain injury as a result of hypoxic or other birth injuries, their mothers were faced with a lifetime of providing round-the-clock care for their severely disabled children.

The inquiry report noted that “In many of these cases, the trauma was caused by mistakes and failures made before and during labour. Frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers.”

 

What does the Birth Trauma Inquiry say about maternity care in the UK?

The Birth Trauma Inquiry found that for many women their maternity and postnatal care lacked compassion and at times they were mocked and shouted at when raising concerns. During labour, birth and postnatally their basic needs (such as pain relief) were denied. Intrusive interventions were carried out without consent and many had not received enough information to make decisions during birth. Postnatal care was almost universally poor, and often degrading and neglectful. Following their birth trauma, women had difficulty accessing maternal health services, owing to long waiting lists or being told they didn’t meet the criteria for help.

Women from minority ethnic groups received particularly poor care, with some experiencing racism. Women’s partners  were also affected psychologically by witnessing their partner’s traumatic birth,  but their needs were often disregarded both during and after the birth. Maternity professionals described overwork and understaffing as a common occurrence in maternity units, and many referred to a culture of bullying.  The inquiry revealed “a maternity system where poor care is all-too-frequently tolerated as normal, and women are treated as an inconvenience.

 

Birth trauma from stillbirth and neonatal death

The inquiry found that almost all of the stories which involved the baby’s death during labour (stillbirth) or shortly after birth (neonatal death) featured mistakes made during labour and a lack of compassion towards the mother. Women who went into labour prematurely during the second trimester (weeks 13 to 27) of pregnancy were disbelieved, leading to the death of their baby. Women experiencing stillbirth were made to go through labour on wards with women with live babies, and postnatally, mothers of stillborn babies were denied postnatal six-week GP checks.

 

Vaginal/perineal tears and obstetric anal sphincter injuries (OASI)

The Birth Trauma Inquiry heard from women who had experienced third or fourth-degree tears, also known as obstetric anal sphincter injuries (OASI). National figures suggest that 3.1% (around 14,000 each year) of all vaginal births in the UK result in OASI, but this does not include those that are missed or not talked about. Risk factors for OASI include first vaginal birth, instrumental or assisted birth with Ventouse or forceps, prolonged second stage of labour, poor positioning of the baby in labour or shoulder dystocia, babies with birthweights exceeding 4kg or babies who are born very quickly, as well as mothers who are older, shorter or of South Asian ethnicity. Many women told the inquiry that nobody had discussed the risks of OASI with them during their pregnancy.

The inquiry heard medical evidence which advised that if an OASI is diagnosed and repaired shortly after birth, a full recovery is possible, however, the medical expert, Professor Keighley, also advised that he had seen more than 200 women with third or fourth-degree tears in recent years, and in 60% of those cases the tear had been missed at the baby’s birth. The inquiry heard from many women whose tears or rectovaginal fistulas (hole between the rectum and vagina) had been undiagnosed or misdiagnosed as less severe, resulting in significant long term problems, including ongoing pain, multiple surgeries, bladder and bowel incontinence, sexual dysfunction, difficulties with daily activities, working, going out or socialising, and bonding or relationship difficulties with their partner, child and friends.

An OASI care bundle which was developed jointly by RCOG and RCM and successfully piloted in the UK includes recommended actions which are known to reduce OASI, but to date has not been implemented in all maternity units.

 

What themes did the Birth Trauma Inquiry find in UK maternity care?

The Birth Trauma Inquiry emphasised that for most of the women who suffer birth trauma, the medical emergency only forms part of the trauma. The inquiry found that the birth trauma was often compounded by the birthing or postnatal women’s distress at being neglected, ignored or belittled when they were at their most vulnerable, whilst experiencing terror, shame, humiliation, embarrassment and feeling ‘broken’ as well as fear that they or their baby would die.

Common themes amongst these women’s experiences included:

  • Failure to listen to women’s concerns or calls for help, or dismissing women as over-anxious, in some cases whilst they were suffering extreme pain, internal bleeding, obstetric haemorrhage, faecal incontinence or signs of other serious conditions,  or noticing red flag symptoms such as jaundice in their baby. In one case a woman chased 44 times for a scan after her measurements in pregnancy were reduced, only to have the scan refused and the baby die stillborn from IUGR (intra-uterine growth restriction).
  • Lack of informed consent about the risks of tears and other complications, being mocked and having their requests for caesarean section or pain relief during a difficult labour denied, or being asked (too late) to give consent for interventions whilst affected by gas and air, anaesthetic, severe pain or other mentally compromising circumstances during labour.
  • Poor communication and mix-ups of patients’ information and test results, resulting in unwarranted interventions and accusations. In one case the family were given vague but simultaneous advice about their child’s potential dyslexia, cerebral palsy or end-of-life care, and received a congratulatory call from an uninformed health visitor after their baby died.
  • Lack of pain relief was a common feature, with women being denied pain relief and chastised or mocked for their distress during labour or postnatal stitching of vaginal tears.
  • Lack of kindness and compassion was overwhelming, with postnatal women describing being left alone, catheterised, covered in blood and faeces, and unable to wash and with nobody responding to requests for help, but chastised for not getting up to clean or breastfeed their baby for the first time. Unkindness was also prevalent in the care of bereaved mothers or in women who struggled to breastfeed.
  • Poor postnatal care was almost universal, with women being left alone, often unable to move after an emergency caesarean or difficult forceps birth, with nobody to help them go to the toilet or lift their baby, or being terrified when nobody responded to their calls for help when they were alone with their baby but severely haemorrhaging. Many postnatal women were left to lie in their own blood, urine or excrement, or even berated by midwives for having soiled themselves. One mother who was on an antibiotic drip for sepsis after emergency caesarean was handed her soiled and vomit-covered baby and told to clean the baby as the midwife left the room to join the laughing midwives who were ordering a takeaway at the nurses' station.

The inquiry found that the poor care continued after the women left hospital. Mental health symptoms from the traumatic birth were ignored or treated dismissively and where six-week checks with the GP took place, they were cursory and rarely focussed on the mother, leaving her birth injuries undiagnosed.

 

Birth Trauma Inquiry found poor response to women’s hospital complaints after failings in care

The inquiry found maternity hospitals are not complying with the statutory duty of candour when things go wrong and many women’s birth trauma was made worse by the hospital’s dismissive and insensitive response to their complaints. Birth records were often falsified or lost, and one woman reported that the hospital challenged her recollections and prevaricated, stringing out the process for over a year before finally admitting their failures.

For others, the three-year deadline for making a medical negligence claim had passed by the time they felt able to seek advice. The Birth Trauma Inquiry’s recommendations included extending the limitation time limit for making maternal birth trauma negligence claims to five years.

If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.