‘Putting women at the centre of their own care, listening to them, learning lessons from both failed and successful maternity services is crucial to delivering safer better care’ – that’s the message from the Royal College of Midwives (RCM) as it responds to a new report on birth trauma.
The report by the All-Party Parliamentary Group (APPG) and the Birth Trauma Association follows the UK’s first-ever inquiry into birth trauma to which the RCM provided evidence in February.
Safe levels of staffing and ensuring there are enough midwives so they have time with women particularly during antenatal appointments to pick up issues early on. In addition to discussing concerns and making decisions around birth choices and infant feeding choices is fundamental to delivering good quality maternity care says the RCM.
The RCM says it also supports the reports call for the reinstatement of a Maternity Commissioner with accountability to the Prime Minster, this the College says is very much needed particularly as their remit would include a commitment to tackle inequalities in maternity care for Black, Asian and minority ethic women.
Commenting, RCM’s Chief Executive, Gill Walton said: “Sadly, not all birth experiences are positive and poor experiences can have a devastating impact on woman and should be taken very seriously as a threat to maternal mental and physical health and infant wellbeing.
“The women who shared their experiences with the inquiry must be commended for doing so and we owe it to them to learn and improve from the failings that happened in their care. Undoubtedly staffing shortages drastically impact the safety and quality of care that midwives can and so want to deliver.
“Our own members tell us they are struggling to give women the time and quality of care they need and deserve. Also, with the rise in more complex pregnancies, having the right skill mix of staff on shift is key.
“Access to appropriate training has also been highlighted in this report and when there aren’t enough midwives, crucial training is often postponed and this impacts how prepared staff can be for not only emergency situations, but how improvements in day-to-day maternity care can be achieved.”
Solving the midwifery recruitment and retention crisis with practical solutions must be the number one priority for any incoming Government says the RCM who recently published ‘How to Fix the Midwifery Staffing Crisis’ a practical guide which contains solutions for the next UK Parliament.
Included in the key recommendations is a plea for mother’s health records to be digitised, this is something the RCM has long called for. Assessing and documenting risk in an electronic record is essential to providing safer effective midwifery care. The RCM has already published an Electronic Guidance and Audit tool and has called for midwives and maternity support workers (MSWs) to receive appropriate training on electronic record keeping systems used in their Trusts and Health Boards.
The report also highlighted the difficulty many women have in accessing maternal mental health services. Mental ill-health ranks with physical factors as one of the leading causes of maternal deaths in the UK, and yet this is not reflected in the resources allocated to it says RCM. Last year the RCM called for the postcode lottery provision of perinatal mental health services to be tackled urgently and published a ‘perinatal roadmap’ which laid out recommendations to improve perinatal mental health care in the UK.
Commenting on that, Gill Walton added: ““We need to ensure that every Trust or Health Board in the UK providing maternity services has a fulltime perinatal specialist midwife.
“This would make an enormous difference and enable midwives to refer women in their care to someone in their service for immediate support. The RCM also believes and have advised that all maternity professionals should be equally concerned with mental as well as physical health in pregnancy, childbirth, and postnatal period.
“Also, the recommendation of a standardised post birth service for give mothers a space to speak about their experiences we would support, but this is something that needs separate levels of investment. It’s important too that fathers and birthing partners who have witnessed a traumatic birth have access to the right support and help postnatally.”
Health and Social Care Secretary speech at birth trauma APPG
A speech the Health and Social Care Secretary, Victoria Atkins gave at The All-Party Parliamentary Group on Birth Trauma
Good evening everyone. It is an absolute privilege to be speaking to you all this evening as we mark the launch of the first ever Birth Trauma Inquiry report.
And I’d like to start by May by thanking my dear friend Theo (Theodora Clarke MP) for her strength in speaking out about her own experiences and in so doing, creating this incredible workstream whereby other women are being invited to give their experiences and to be listened to.
I mean, Theo is, to my mind the exemplar of a parliamentary powerhouse, and it’s been an absolute pleasure working with you, but also I genuinely think the work that you have achieved will have very, very long term and positive benefits for women across England.
The reaction that you have received from women shows just how critical this work is.
You have given a voice to those who may never have shared the pain and the suffering that they have been through, or when they have spoken up, they have not been listened to.
And so, thanks to you and to the brave women in this room, but also the many, many brave women who have contributed to this report, or who have shared their stories today with media outlets, as it has rightly got such media attention.
But thanks to those brave women, things are changing and you are shining a bright light on the struggles that too many women face, and you are putting birth trauma at the heart of our national conversation, and ensuring that other mums do not have to suffer in silence.
And I’d also really like to thank the wider APPG, co-chaired by Theo but also by Rosie, and both of whom have really demonstrated, along with APPG colleagues, just how cross-party working can work to the very best for us as a country.
And so thank you to every single parliamentarian involved in the APPG.
And in that spirit, I am determined to make care for new mums and mums-to-be faster, simpler and fairer because the birth of a child should be amongst the happiest moments in our lives.
Theo said of course, the overwhelming majority of families it is.
Each week around 10,000 babies are born in England on the NHS and most of them are born safely and with mothers and families reporting a good experience of the care they receive.
But we want that for every woman and every family.
And as this inquiry demonstrates so starkly, there is far too much unacceptable variation across the country in the service that women receive.
Some mums endure simply unacceptable care and live with the consequences of that trauma for the rest of their lives.
Now I’ve been open about my own experiences with the NHS.
The NHS is genuinely one of the reasons I came into politics.
I was diagnosed with type one diabetes at the age of three and I’ve seen the very best of the NHS, but I’ve also seen some of its darker corners and that includes in my own experience when I was pregnant.
Aa you can imagine the clinicians in the room will understand a type one diabetic having being pregnant brings its own complications. And I had wonderful, wonderful care in many, many instances. But I also had examples where I wouldn’t wish other women to go through the same, including and I’ve spoken about this, I was rushed into hospital earlier than anyone had planned, and I was put on a ward, heavily pregnant, not quite knowing what the future was holding for me or my baby.
And, I was on the ward where women who had just experienced extremely traumatic, dare I say it, dangerous births were being rushed from theater onto the ward where I was.
Now clearly those their experiences were far, far worse and far more traumatic than my own.
But you can imagine the how frightening actually that experience was for a first-time mum to be, with the concerns that I was having to live with at the time.
So just that, as an example, I know everybody was trying to do their best at that point, but I desperately want to ensure that women who are expecting and who need additional support don’t find themselves in similar or even worse situations as I did.
And I want to make sure that no woman goes through a physical and mental trauma, and while giving birth, that could have been prevented.
Now I know that the Women’s Health Summit in January, Dame Lesley Regan and I talked about and forgive me, gentlemen, we talked about the NHS being a system that was created by men for men.
And that struck a chord with many women, particularly those who know Lesley and know she is another female powerhouse And the truth is that women have suffered in pain that would simply not be tolerated in any other part of the hospital.
Women have tried to raise concerns about unacceptable care, but they’re being told it’s all just natural.
And it is that, if you like, silencing, that really should not be the reality that women face in the 21st century.
We can and we will do better.
Now, being made Health Secretary in November, I have been impatient to make progress.
And that is why in January I held the Women’s Health Summit, where I made birth trauma one of the top priorities for the second year of the Women’s Health Strategy.
And I want to make this year not just the year that we listen, but that we act and that this is happening now.
We are rolling out new maternal mental health services for new mums, which are already available in all but three local health systems.
We are, believe you me, paying close attention to those final three areas to make sure they finalise their plans at pace this year.
On physical injuries too, we are rolling out improved perinatal pelvic health services, including guidance to better support women who experience serious tears and to prevent these from happening in the first place.
We’re halfway through. We plan to get to full coverage by the end of the financial year. And these services will be supported by our announcement at the Spring Budget of an extra £35 million pounds more for more midwives and better training for when things go wrong.
On top of the extra £186 million pounds a year, we are already investing into maternity services and safety compared to three years ago.
And thanks to Thea, we have also introduced standalone GP appointments six to eight weeks after giving birth to ask those crucial questions about whether mum is okay while keeping separate checks for her baby, because we know a happy, healthy mum means a happy, healthy baby.
And this is supported by new guidance to prompt, direct questions about their birth experience, even if there is nothing in her notes to suggest that the birth was traumatic.
I want to embed a culture that listens to women right from the start of their pregnancy, and so I’m delighted that NHS England are co-producing new decision-making tools with new mums to help guide through choices on how they give birth, what interventions could happen and what pain relief they should be offered.
These will be made available in a range of languages and formats to make sure that they can be tailored to different settings and to different local populations, because the ethnic disparities that Kim and Theo have highlighted have to be tackled, and we are determined to do that.
Theo’s speech in Parliament spoke to the lasting impact that birth trauma can have on the whole family. And of course, dads and partners are very much part of that. And so I’m extremely grateful to Theo’s husband for making that point.
But also we have listened in government and Maria Caulfield, my minister, who is responsible for men’s health along with a great many other things, will be chairing the next session of the Men’s Health Task and Finish Group in June to focus on dads mental health and trauma so that we can better understand how to support partners.
And I’m delighted to announce that the National Institute for Health and Care Research (NIHR) will commission new research into the economic impact of birth trauma, including how this affects women returning to work.
That’s a really important idea and a really important commitment.
I know there is so much work to do to deliver on the detailed findings of this report and I, together with NHS England, fully support the APPG’s call to develop a comprehensive cross-government national strategy for maternal care.
I’m very grateful to the NHS for the progress that have been made so far on the three-year delivery plan for maternity and neonatal services, but I want to go further and a comprehensive national strategy will help us to keep driving that work forward while making sure everyone across government and the health service are crystal clear about what we need in maternity services to focus on.
And I also want to be clearer to mums and those looking after them, what their rights and expectations should be, so that everybody can be clear about the standard of care that mums deserve.
So watch this space.
Now in conclusion, this is the first time in the NHS’s 75-year history that I, as the Secretary of State, but also the Chief Executive of NHS England, are both mums.
We get it.
And for this, this is not just professional, it is personal.
Both Amanda and I take our responsibilities to all of you incredibly seriously and I have to say more soon on how I plan to make this area of our health system faster, simpler and fairer.
So I want to finish by thanking you, each and every one of you that has been involved in this report, for everything you have done to kickstart the national conversation about birth, trauma and how women should be listened to and their concerns acted upon.
And I really look forward to continuing this conversation with you in the months ahead.
Thank you so much.