Birth Trauma Injury Report – Listen to Mums: Ending the Postcode Lottery on Perinatal Care

It has been apparent for some time that there is a crisis in maternity services in the UK. Enquires in relation to maternity services at Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham University Hospitals have all highlighted issues in maternity services at these Trusts.

Initial findings

In January 2024 an all party parliamentary committee, chaired by Theo Clarke MP, began an inquiry into maternity services in the UK. On 13 May 2024, Theo Clarke MP, published the inquiries’ report into birth trauma.

The report states “The stories told by parents were harrowing. They included accounts of stillbirth, premature birth, babies born with cerebral palsy caused by oxygen deprivation, and life-changing injuries to women as the result of severe tearing. In many of these cases, the trauma was caused by mistakes and failures made before and during labour. Frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers.”

The inquiry heard a variety of stories in relation to birth trauma. It heard devastating accounts from women who had experienced obstetric anal sphincter injury (OASI), causing permanent pain and bowel incontinence. They heard of the impact on these women who are often unable to return to work, and the profound impact on their self-esteem. They also heard from women who now provide care for children left severely disabled as a result of birth injuries. Tragically these are stories that we recognise and hear on a daily basis. It is perhaps for this reason that such a large percentage of the NHS Litigation budget is paid out in respect of injuries sustained during birth (13% 2022/23)

Themes of the enquiry

The most common themes found during the inquiry were:

• Failure to Listen: a failure to listen to women when they felt that something was wrong;
• Lack of Informed Consent: risks, such as tearing, are not explained sufficiently antenatally;
• Poor Communication: both during labour and also when issues were identified;
• Lack of Pain Relief: women being given only paracetamol for acute pain;
• Lack of Kindness: a lack of kindness and compassion to the mother in traumatic situations;
• Breastfeeding Problems: and particularly women being made to feel as though they were a failure if they were not able to do this;
• Postnatal Care: this was found to be a near universal failing across the UK
• The impact of COVID: an acute increase in post-traumatic stress for women giving birth in 2020/21
• Complaints and medical negligence: the birth trauma was made worse in many cases by the way in which Trusts deal with complaints and medical negligence claims, often failing to acknowledge failures in care.

Other report findings

The report also highlighted that around 4-5% of women suffer PTSD following a traumatic birth.

The inquiry also heard from partners who had suffered psychologically after witnessing traumatic birth, who also felt unheard and unseen. This is particularly noteworthy in light of the recent Supreme Court decision in Paul (11 January 2024) which means that even when the trauma has occurred as a result of the most serious negligence, these “secondary victims” are now unable to recover damages.

Key conclusions of the inquiry

The key conclusion of the inquiry is that maternity services across the UK require improvement and that, at present, there is no single overarching document governing maternity services.  This Inquiry has called on the UK Government to publish a National Maternity Improvement Strategy, led by a new Maternity Commissioner.

The National Maternity Improvement Strategy would outline ways to:

1. Recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services and provide mandatory training on trauma-informed care.
2. Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.
3. Offer a separate 6-week check post-delivery with a GP for all mothers which includes separate questions for the mother’s physical and mental health to the baby.
4. Roll out and implement, underpinned by sufficient training, the OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce risk of injuries in childbirth.
5. Oversee the national rollout of standardised post birth services, such as Birth Reflections, to give all mothers a safe space to speak about their experiences in childbirth.
6. Ensure better education for women on birth choices. All NHS Trusts should offer antenatal classes. Risks should be discussed during both antenatal classes and at the 34-week antenatal check with a midwife to ensure informed consent.
7. Respect mothers’ choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.
8. Provide support for fathers and ensure nominated birth partner is continuously informed and updated during labour and post-delivery.
9. Provide better continuity of care and digitise mother’s health records to improve communication between primary and secondary health care pathways. This should include the integration of different IT systems to ensure notes are always shared.
10. Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
11. Commit to tackling inequalities in maternity care among ethnic minorities, particularly Black and Asian women. To address this NHS England should provide funding to each NHS Trust to maintain a pool of appropriately trained interpreters with expertise in maternity and to train NHS staff to work with interpreters.
12. NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.

Unfortunately the issues which have been highlighted in the report are issues that we recognise only too well. The proposals for a National Maternity Improvement Strategy are positive and the proposal to extend the time limit for medical negligence litigation relating to childbirth from three years to five years would allow mothers more time to come to terms with life changing injuries before having to contemplate taking on a litigation claim.

Get support and speak to an expert

For any woman who has suffered a traumatic birth there is help available. Charities we work with, such as MASIC and Lily Mae Foundation offer help to women who suffer OASI and babyloss.

Clarke Willmott are extremely experienced in dealing with claims involving traumatic birth injuries. If you, or someone you know, has suffered a traumatic birth and would like further advice in relation to pursuing a legal claim then we would happy to speak with you.