‘I’m Beatrice’s mum, and because she’s dead, this is the only way I can be her mum,” Emily Barley said of her campaigning a year after her daughter died during birth.
Beatrice should have been born a healthy baby in May 2022 but lost her life because of catastrophic errors by staff at Barnsley hospital that included mistaking Emily’s heartbeat for her daughter’s and a failure to intervene with an emergency caesarean despite Emily repeatedly raising the alarm. Emily has since devoted herself to campaigning for safe maternity services, setting up the Maternity Safety Alliance with other parents whose babies would be alive were it not for appalling failings.
I first spoke to James Titcombe a few years ago about the death of his son, Joshua, at Morecambe Bay NHS Trust, and I can scarcely believe that in 2023 I’m having yet another conversation with yet another parent about the loss of their baby in similar circumstances; yet another parent who’s had to park grieving to try to force the NHS to prevent it happening again. But 15 years after Joshua died, eight years after the inquiry into the systemic failings at the NHS trust where he was born was published, and with a slew of other inquiries into similar failings at other hospitals completed or under way, things seem to be getting worse, not better.
New analysis last week showed two-thirds of maternity services inspected by the Care Quality Commission (CQC) are not safe enough. One in seven was ranked “inadequate” on safety, with a high risk of avoidable harm to mother or baby. Extraordinarily, there has been no national data published on avoidable baby deaths since 2018, when 1,145 babies suffered death or serious brain injury, many as a result of poor care.
But freedom of information data has shown that, while the number of babies born with brain injuries and early neonatal deaths has fallen slightly, the number of intrapartum stillbirths during labour has increased from 118 to 192 in the last three years. Despite a government target to reduce maternal deaths between 2010 and 2025, they have increased by 15%. Mothers in the UK are three times more likely to die around the time of pregnancy than in Norway; there is no national data on serious and avoidable injuries to mothers. And outcomes are significantly worse for mothers and babies from minority communities: black and Asian mothers are four and two times as likely to die as white mothers, and black and Asian babies are twice and 1.5 times as likely to be stillborn as white babies.
Maternal and baby deaths are thankfully rare, which is what allows the NHS to claim that giving birth in the UK is generally very safe. But that’s of scant comfort to the parents of the 800 or so babies a year whose lives are lost or irrevocably damaged by poor maternity care. And deaths are the tip of the iceberg; while countless mothers will have healthy babies in spite of unsafe services, many will experience unnecessarily traumatic births; women’s experiences of care have deteriorated in recent years.
On paper, we know what safe maternity care looks like. But inquiry after inquiry has described failings so basic and parochial that they are scarcely believable. Why on earth are maternity services the most unsafe part of the NHS?
The stock answer the Royal College of Midwives goes to time and again is poor staffing levels. Of course, staffing and funding are part of the story – but they are certainly not all or even most of the explanation. These failings also happened in better-funded days; the inquiry into East Kent where 45 babies died from poor care found lack of staffing was not a “causative” factor. Too often, the culture in hospitals is to double down and become defensive rather than learn from mistakes – but like staffing issues, this affects the whole of the NHS.
Two things mark maternity care out from the rest of the NHS. The first is that this is the most significant area of healthcare concerned with a uniquely female experience. Of course, it affects dads, too, but they are also victims of a patriarchal healthcare system that doesn’t trust women’s accounts of their own bodies and pain. Medics and midwives failing to listen to women is a constant refrain in investigations of what went wrong.
Nowhere is this more apparent than in research with black and Asian women, whose outcomes are significantly worse than white women, even after you take into account they are more likely to be poor and have pre-existing health conditions. According to a leading academic, Marian Knight, maternity care – like menopause and endometriosis care – also suffers from a lack of research, including into how to predict which births will require more specialist intervention.
The second is that it isn’t purely medical. For many women who plan to have a vaginal birth, care will be midwife-led, and midwives will function as gatekeepers to medical intervention if needed. But this arrangement can lead to territorial disputes between midwifery and obstetrics, or decisions being made not in the interests of mother and baby but in order to prevent medical intervention. At its most extreme, this takes the form of a harmful attachment to “normal birth”; in Morecambe Bay, midwives avoided medical birth “at any cost”; in Shrewsbury and Telford there was a multi-professional aversion to it “at pretty much any cost”; in East Kent some cleaved to “normal birth” as an ideal women should strive to achieve.
Birth is more innately risky than a few decades ago, because women are having children when they are older, with more complex health needs. But the wonders of modern medicine mean that, with correctly delivered healthcare, birth should be safer than ever, with the right medical intervention at the appropriate time for women and babies who need it.
But that isn’t working for the families of hundreds of babies who are avoidably dying or getting seriously injured as a result of failings that should be eminently fixable. Their deaths are an indictment of the system’s inability to learn and improve. It is why James, Emily and other parents involved with the MSA are right that there must be a judge-led public inquiry into systemic maternity failings across the NHS.