Access to news reporting has never been more available, with the internet and social media constantly on tap. The rise of the need for ‘fact-checking’ has also become more prevalent, as the truth of reports is questioned. Neil Stewart, Editorial Director of the maternity and midwifery forum, considers some of the recent issues reported in media outlets and challenges us to see what is really happening in Maternity.
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In 10 days that shook the world President Trump provided a classic example of the clash between the real world and the reported world. How narratives compete for attention and can be self serving and selective to change behaviour – some good some bad.
In the reported world President Trump announces that President Zelenskyy is a “Dictator” because he has not held elections during a war. In the real world he was elected, and still has majority support and, like Churchill, only postponed elections that war makes impossible to hold.
In the reported world President Trump announces that Ukraine started the war. In the real world we all saw what happened live in Feb 2022 – Russia invaded Ukraine.
But the more President Trump says it, the more some people will think there is something behind it and begin to doubt the evidence they can see in the real world.
This is often described as “gaslighting”, pushing a narrative till people are confused and don’t know what to believe.
This is important because it begins to have real world effects as we will see over the coming weeks and months.
What has this got to do with maternity services?
Maternity services are going through their own version of this competition between the reported world and the real world maternity staff see with their own eyes.
In the reported world over half the maternity units are “unsafe”.
In the real world the CQC reports that around 10% are “inadequate” which requires urgent action. The rest are accounted for by falling short in one area or another but not being judged overall as “unsafe”, since that would mean closure. But the reported headline attracts more readers.
In the reported world women are bullied by midwives into holding out for “normal birth” to the extent that maternity and midwifery organisations have been jostled into not even using the term “ normal birth” in case it denies a woman a right to a Caesarean Section.
In the real world out of around 600,000 births, 90,000 are already planned C Section but there are then around a further 120,000 emergency C Sections not explained by maternal choice, age, obesity, diabetes or the other elements in the planned C sections.
In the real world maternity units are reporting C section rates of 50% or more and the obstetricians in Northern Ireland in the Renfrew report on maternity safety predict it will go to 60%.
In the reported world the number of midwives has risen by almost 4000 while the birth rate has fallen so ratios should all be fine and there should be no shortage and more personalised care.
In the real world the RCM calculates that 2500 more are needed and in world of high surgical procedures it is easy to see why units feel overwhelmed. And the CQC reports staff shortages as one of its consistent key safety shortfall findings.
In the reported world midwifery education places are up and new qualified midwives are coming online to meet the demand.
In the real world the RCM reports that, at the last count, 15% of these students were not completing their courses. Lead Midwives for Education report that the drop out rate is moving up to 25% defeating the extra recruitment; plus a new development of students qualifying to be a midwife, to prove they got a degree, but then deciding to go and pursue a completely different career.
In the reported world childbirth is treated as an emergency; even the great Lord Darzi, whose report last summer is guiding the NHS Plan, made the short-lived mistake of putting Gill Walton the CEO of the RCM in his emergencies working group, before being sharply reminded that pregnancy is not an emergency.
In the real world with lack of continuity of carer, overworked units, staff shortages, it is too often perceived as an emergency, feels like an emergency to mothers and partners dealing with frantic staff, and is treated like an emergency by busy hospital processes and procedures, perhaps contributing to turning it into real emergencies.
But the reported world can and does have effects and can turn into the real world.
As more women hear and see these reported stories without the real context of how safe maternity services really are, they turn to what they see as the lesser danger, lesser risk of a planned C section. Besides the rise in Tokophobia, the fear of childbirth, there are now visible social trends among women exercising their choice and demanding a caesarean birth where no clinical indicators suggest one is needed.
If you have been horrified at the way the reported world on Ukraine or Gaza does not match the real world you have seen it is worth reflecting that this is happening at a different level in maternity services.
You may not be able to do much about Ukraine or Gaza, but you can do something about maternity services to stop commentators saying it is all a disaster area, unsafe or frightening.
Over the next few months childbirth will be in the news because of various reports and books due to be published.
Maternity services need a response and opinion leaders are now looking to the Renfrew report into maternity services in NI, which is the first and only safety report to look for statistics and best practice across the UK to inform its findings.
It has been welcomed as a plan for Northern Ireland, it should be looked at as a plan for the rest of the NHS. It reads like it is based on the real world.
Neil Stewart, Editorial director
February 2025