Increasing levels of trauma from the birth process is being recognised globally. In the UK a cross party Parliamentary group has published a report on Birth trauma, Listen to Mums: Ending the Postcode Lottery on Perinatal Care. Neil Stewart, Editorial Director for the Maternity and Midwifery forum, reflects on the political impact of the report and the response by the maternity professions.
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Last week was a discovery moment in British public consciousness. A mix of Parliament, the Media and unavoidably powerful personal stories bring to full public awareness something hidden in the shadows, though visible to professionals and specialists. Discovery stories go back as far as Cathy Come Home in 1966, a play about the cruelty of homelessness; we are in the middle of one with Mr Bates vs the Post Office, revealing astounding institutional victimisation and indifference.
The Birth Trauma report from the Parliamentary All-Party Group is one of those moments: a discovery moment that will have repercussions for the whole of maternity and for midwifery. It already is with the official recognition of Birth Trauma, the new 8-week GP check not just on the child but the mother, and new mental health funding announced in January. It is not often that you see a government trying to get ahead of an issue and that is to be welcomed.
Midwifery has been well aware of Birth Trauma for a long time. Here at the Maternity and Midwifery Forum we experienced a warning sign that this was not something exceptional that happened to just a few women but might be more systemic. At a conference of 700 midwifery and maternity staff in London a small breakout session on Brith Trauma was overwhelmed when virtually the whole conference tried to attend one breakout. Repeated over the day, it was clear the midwives were not only speaking about the trauma they had seen women suffer, but they were also talking about their own birth trauma, not listened to, not in control, even as experienced professionals. In addition, many talked of the trauma that was reawakened when a woman they cared for suffered a traumatic birth. The Birth Trauma Association, which has be in existence for 20 years, did much initial public campaigning, especially on the extreme effects of postnatal depression. But it is only now, following the reports of Ockenden, East Kent and now the All Party group, that the full range of birth traumas is being understood: from miscarriage through to lasting clinical, physiological and mental impacts lasting a year or more with life changing impacts not just for the women but their families, their relationships, their economic chances and the wellbeing of their children. It is vital to acknowledge this reality and improving practice and care for affected people is crucial.
Such a moment is always a dilemma for a profession, when hard to hear news, critical of the service and the professions, hits the headlines. I recall experienced midwives enraged by the failings of other midwives in the Shrewsbury and Telford report, making no excuses for indefensible behaviour. That has to be the right stance no matter how many factors might have contributed to failings, the failings need to be called out and addressed.
Theo Clarke Conservative MP, along with Rosie Duffield MP, from the other side of the parliamentary spectrum, has done an extraordinary job of navigating a hyper emotive subject to suggest a number of long-term solutions that everyone should be able to support and ‘get behind’.
Every now and then an MP comes along who picks up a subject much ignored and elevates it into an unavoidable challenge to professions, power and authority. Theo Clarke looks like one of those MPs who make a difference in the way we all hope politicians would. She does this, not least, because she speaks from her own experience of traumatic birth, putting her own difficult story out in public, and on 19th October 2023 she initiated the first ever parliamentary debate on Birth Trauma. From that moment the clock has been ticking toward last week’s Birth Trauma report.
The report itself has twelve recommendations which start with the need for 2500 more midwives. This is not just about recruiting new but retaining existing midwives. It points to better postnatal checks, completion of the roll out of the OASI bundle, the NHS to run ante natal classes and talk more about the risks of childbirth, better involvement of fathers and partners, a commitment to continuity of care, extension of the period to initiate litigation to 5 years, and tackling the racial inequality experienced by Black and Brown skinned mothers.
These have all been on the midwifery demand list for some time and, while some will feel challenging – for example allowing more litigation time and putting the risks of childbirth front and centre in ante natal classes – the service and profession needs to push for them all – women now expect no less, and maternity and midwifery succeed when they aligned with women’s campaigns.
There are two proposals which came out of the report I want to highlight and suggest that the profession run with, and demand are included in political manifestoes – about which this is a great moment of opportunity.
The first is the Maternity Commissioner who, when appointed, should report to the Prime Minister. This appeared in the forward and led the headlines and is a recommendation which may not be welcomed in either the Department of Health or No 10 as it puts both on the spot in the future. Which is why is it needed. I did wonder if its appearance in the forward was a necessary last-minute step to avoid being “nobbled” by the whips and government. Maternity and midwifery keep being pushed down the agenda and needs an appointment like the Childrens Commissioner, a balancing force that keeps all the other issues and recommendations front and centre is good, if complicated, and sometimes painful for everyone including the profession.
It is also a good proposal because we are seeing other bodies like the CQC sweeping through maternity services with one-word categorisations of units. Something that pushes positive change and better debate is to be welcomed. If some mischief makers suggest this undermines the Chief Midwife role or that of the specific health ministers, I do not think experience in other departments supports that. There will be uncomfortable days and reports with a Maternity Commissioner, but another lever will exist to prioritise maternity and midwifery services that we have been struggling to achieve in an era of austerity and post COVID.
The second is the proposal that the National Institute for Health and Care research (NIHR) should commission an economic study of the cost of Birth Trauma and the lifelong impacts, not just on the women, but the demands on the service. This may at first seem a cold calculation, but it is the essential data of modern campaigning and the starting point for an argument with the treasury about priorities and effectiveness. In addition, once this kind of research starts, the door will be open to much better data, episode counting and cross referencing of conditions and the sources of birth trauma as the essential steps of identifying prevent, support and postnatal care.
We should run hard with this report and push for those two recommendations to be included in manifestos with the oft promised and oft not fulfilled promise of extra education and extra midwives. Government often gets off the hook on other promises; a Maternity Commissioner, like the Children’s Commissioner is not a hook they can get off.
May 2024
Neil Stewart