The latest report on maternity care in the UK hasn’t told us anything new. The headline finding of the parliamentary inquiry into birth trauma is that poor care is ‘all-too frequently tolerated as normal’, with women’s concerns and requests for pain relief being dismissed, poor postnatal care where women who couldn’t move after surgery were berated by midwives for having soiled themselves or for asking for help, and a failure of hospitals to deal sensitively with complaints about poor care.
All of this is shocking. Yet anyone who has read the Ockenden Review of the maternity services at Shrewsbury and Telford Hospital NHS Trust or the Kirkup review of East Kent maternity and neonatal services, or indeed Kirkup report into Morecambe Bay NHS will recognise the same pattern: a service that seems to operate with itself in mind, rather than the women in it.
This has largely been the case since the inception of the NHS: it’s just that the ideology over birth has swung around a bit. In the 1960s and 70s, birth had become highly medicalised and women were often treated appallingly by a very patrician system that paid little heed to their pain. By the 1980s and 90s, the influence of the National Childbirth Trust and radical midwifery campaigners meant the pressure for ‘normal birth’ affected the way NHS services were performed, often with little heed to the wishes and pain of the mothers. Women and their babies have seemed like an afterthought throughout the delivery of maternity services.
The ideological battle is not, by the way, confined to the NHS: it is something that has been raging in western healthcare for a good while. Some of the ideology around women being able to give birth without pain relief comes from the Soviet Union where (mostly male) doctors theorised that simple breathing exercises would be able to replace analgesia: suspiciously convenient given there were shortages of pain relief. What it has led to is a culture where stories of women who have easy births are celebrated and treated as ‘normal’, whereas women who have complicated labours needing surgical intervention are left feeling guilty that they didn’t spend enough time sitting on a birthing ball, doing pregnancy yoga or reciting affirmations.The word ‘tearing’ is barely used, despite it being common during vaginal labour. The President of the Royal College of Obstetricians and Gynaecologists told an evidence session that:
We often don’t talk to them because we think that women will be frightened and they will want to have a caesarean section if we tell them about birth trauma, but research that we have done has actually shown us that women want to know, they want to know the details and they will be the people who will make the decisions.
Women want to be treated like adults and given the information they need. Clinicians have too often acted like women are too stupid to make decisions about how they can have a safe birth.
There is also a casual cruelty about many of the accounts in today’s report and all the others published over the past few years. Ockenden recounted mothers who had been told their pain was ‘nothing’, as though a midwife might be able to objectively measure what another person was feeling. James Titcombe, whose son Joshua died as a result of failings at Furness General Hospital, wrote an extremely painful and tender account of his son’s short life and his attempt then to get justice. There are many appalling moments in this book, but one of the smaller ones sticks in the mind: when James went to look for help, the midwives were drinking tea and chatting in a break room and didn’t appear pleased to see him at all. Later, as his son was being ventilated, his father arrived. He recounts:
A few moments later, the doctor tells me he needs to be fully ventilated and I’m asked to leave the room. Around this time my dad arrives. He and I hug and we both cry. A young midwife looks at us both, shakes her head then tuts: ‘Haven’t you been through anything like this before?’ ‘No,’ I reply, ‘I haven’t.’
Similarly, today’s report contains an anecdote of a woman in with sepsis and in pain whose baby had been treated for suspected meningitis:
I was not only expected to try and calm her but also change her as she had been sick and was soiled on arrival. Staff pushed her in to the end of the bed, told me to clean the baby up because she’d been sick and was soiled and walked off. I could hear the staff all outside the bay sat at the nurses’ station laughing and planning on ordering a Chinese takeaway before they closed.
Some of this behaviour has its roots in compassion fatigue, which arises in all healthcare settings but particularly when staff are overstretched and undersupported: something all the inquiries have found is rife within the NHS. It is not just ideology that is causing trauma: it is also the way the health service is structured and resourced.
It might be easy to understand how a midwife rushed off her feet and unable to deliver the level of care she would pride herself on for years on end might end up deciding not to feel anything at all towards her patients. But there is no excuse at all for the way the NHS treats people who try to complain. The system is still set up to treat patients as though they have been driven mad with grief or pain or disappointed high expectations – and then drives them mad with the way it ignores their complaints and offers apologies so qualified that they appear to blame the victims for ‘feeling’ they’ve been let down. The wearying thing is that once again, the reports into maternity safety have been highlighting a cover-up culture for years, but the response of the service is, once again, to pretend that there is nothing wrong.
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