On 6 July 2021, the Health and Social Care Committee published its report into maternity care in England. The report looks at maternity care across the country and analyses the progress of the Government so far in its commitments to improving maternity care.
The report sits against a background of improvement measures in this area of healthcare. Between 2004 and 2013, an independent review of maternity safety at Morecambe Bay Trust was held, and found serious failures in care. There were many recommendations for improvement, including the launch of programmes such as Each Baby Counts, Better Births and the Saving Babies Lives Care Bundle.
These initiatives have seen a reduction in the numbers of stillbirths, neonatal deaths and brain injuries as well as maternal deaths. Nevertheless, at the time of the report the results of two independent reviews of care at Shrewsbury and Telford and East Kent Trusts are emerging. These show that not all lessons have been learned.
On 11 August 2021, the Independent hosted a virtual event to review the report of the Committee and the first reports into Shrewsbury. The panel included Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, Senior midwife Donna Ockenden, Chair of the investigation into Shrewsbury Trust and James Titcombe, campaigner for Baby Lifeline and a bereaved father.
This panel came together to discuss how to support out NHS to overcome these issues. As the panel rightly emphasised, the UK remains one of the safest places in the world to give birth. The objective of these investigations is to make it safer still.
James Titcombe’s contributions were particularly resonant. He spoke about the devastating loss of his son Joshua in 2008, at nine days old. James subsequently became involved in the investigation into maternity care at Morecambe Bay Trust. He relayed how the issues occurring are not specific to small maternity units, but are affecting services across the NHS. Indeed, the Expert Panel of the Health and Social Care Committee has found that the Government’s commitments to maternity services in England all require improvement.
Donna Ockenden is leading the investigation into maternity care at Shrewsbury Trust, with the final report to follow at the end of 2021. Ms Ockenden spoke about the main issues in maternity care, citing a lack of understanding of the services that a maternity unit provides. For example, during the first wave of the Covid-19 pandemic maternity staff were redeployed around the hospital, but meanwhile women continued to go into labour and need hospital care. In fact, maternity services should be viewed as “a woman’s A&E department” due to the nature of pregnancy and labour. Ms Ockenden said that of course staff can plan for their shift, but often they cannot anticipate this and will need to react quickly to the needs of mothers arriving at hospital.
Dr Morris agreed, saying that Trust boards and Chief Executives often to not listen or understand the needs of the maternity unit, saying that maternity is “a front door speciality.”
As Terry Donovan discusses in his recent blog on this issue, staff shortages feature as one of the overriding needs of maternity care in the country, hand in hand with blame culture and increased investment into the service. Ms Ockenden recounted her experience of managing budget cuts in a maternity unit. Workforce makes up the largest part of the budget, and so often specialist services such as bereavement care are cut. These services are integral to the experience of families in the maternity unit.
Also crucial to improving safety is communication, across the board. This includes communication between obstetrician and midwife, which Dr Morris said is key. Similarly, there Ms Ockenden has recommended multidisciplinary training within Trusts, including multidisciplinary planning meetings and ward rounds where concerns can be escalated. This approach is important for holistic care of mother and baby, as opposed to a focus on simple tasks.
Finally, listening to mothers is paramount. The report by the Committee has identified that mothers of Black, Asian and minority ethnic backgrounds are far more likely to feel excluded or face barriers to participating in their own care. This will be no surprise, given the report in 2018 by MBBRACE, but still requires urgent progress to redress such a disparity in the experiences of birthing mothers.
Often, mothers also feel pressured to continue with a vaginal birth, which is seen as the hallmark of good maternity care, as opposed to opting for a caesarean section when necessary. All mothers must be supported to make informed choices, where the focus is on the good outcome for mother and baby.
Kingsley Napley is experienced in working with mothers and families when maternity care goes wrong. It is devastating for all involved, and we welcome the Committee’s suggested improvements, from increased budgets, transparent learning and understanding, and personalised care. The desired outcome of every maternity unit should be a “safe, healthy, positive experience of birth” for mother and baby and thankfully this is the experience of most families.
About the Author
Phoebe Alexander joined Kingsley Napley in 2020. She is currently a trainee solicitor in the Medical Negligence and Personal Injury team.