The Maternity Care Crisis: A Look at Finding Solutions to the Failings and Scandals in NHS Care. By EMidwife

Welcome to our first blog, I was asked to write this by a fellow safety campaigner back in February, (before the Birth Trauma Inquiry report) and with a fundamental belief that Maternity care is the cornerstone of any society's healthcare system, reflecting its commitment to the start of life and to the well-being of all new parents. However, over the last 20 + years the UK has witnessed a series of failings and scandals within its maternity services, despite all of the well-publicised reviews and safety measures that have been implemented, standards have not improved, they have worsened and confidence in the NHS and Midwives is at an all-time low. Combine this with the high number of women who want to freebirth, visible on every social media platform and often promoted with the assistance of non- regulated or even struck- off- the- register, ex-midwives, who have since rebranded themselves as "birth keepers" rather than lay or empirical midwives (which also helps them to avoid prosecution if it goes wrong!) The business of promoting physiological birth has never been more popular, or one could argue, more lucrative. Are midwives being forced down this route because the Continuity of Carer model has not been successfully implemented since the Better Births Report in 2016, is this a business model for commissioners to reconsider or simply a lack of acceptance from midwives who still yearn for the staffing levels and budgets that supported this model of care back in the late1990's. The most recent Cochrane review into Continuity of Carer was not supportive from a safety perspective at all, so what are the options going forward.

It does seem as though there are even more investigatory organisations that are there to regulate, but in diffferent ways. Nothing seems jointly owned, reported or shared, you have to wonder if any of them sit together, share their information and openly talk to each other and more importantly the people that work on the coal face about the challenges faced. Since the year 2000, maternal mortality and morbidity rates have worsened and staff morale is at its lowest, with many maternity specific health workers leaving the profession altogether.

Here is a reminder of some of the more notable scandals.

Failings and Scandals:

1.         The Bristol Royal Infirmary Inquiry (2001):

One of the earliest and most significant scandals in UK maternity care occurred at the Bristol Royal Infirmary. An inquiry revealed high mortality rates for babies undergoing heart surgery between 1984 and 1995. Substandard care, lack of expertise, and poor communication were cited as contributing factors. The inquiry led to sweeping reforms in clinical governance and regulation.

2.         The Morecambe Bay Investigation (2004- 2015): The Morecambe Bay scandal uncovered a series of serious failings in maternity care at the Furness General Hospital in Cumbria. A review found that multiple avoidable deaths of mothers and babies had occurred due to a culture of substandard care, poor leadership, inadequate staffing, cover-ups, and inadequate investigations into adverse events. This tragedy highlighted systemic issues within the NHS, including poor supervision and governance and an unhealthy culture of promoting normality at any cost.

3.         The Royal Free Hospital scandal (2002): This involved the deaths of several mothers and babies due to poor care and negligence at the hospital's maternity unit in London. The scandal led to a public inquiry and widespread reforms in maternity care.

4.         The Northwick Park Hospital scandal (2008): A series of failings in maternity care at Northwick Park Hospital in London led to the deaths of several newborn babies and mothers. The hospital was criticized for inadequate staffing, poor training, and failures in monitoring and responding to complications during childbirth.

5.         Tameside Hospital scandal (2013): Failings in maternity care at Tameside Hospital in Greater Manchester resulted in the deaths of at least eight babies and two mothers. An investigation found that the hospital had inadequate staffing levels and failed to provide proper monitoring and treatment during labour.

6.         The Shrewsbury and Telford Hospital Trust Scandal: This scandal is considered one of the largest maternity scandals in the history of the NHS. An inquiry was launched in 2017 following concerns over avoidable deaths and injuries to mothers and babies at the Shrewsbury and Telford Hospital Trust. Reports suggest a pattern of failures including substandard care, inadequate staffing, and a lack of accountability and suspension of the midwifery continuity of care model. The final report cites 6 investigations and subsequent recommendations before the Donna Ockenden review, but again similar themes stood out.

Current State of Maternal Health:

Despite these scandals and the subsequent reforms, the UK still faces challenges in ensuring safe and high-quality maternity care. Maternal mortality rates, while relatively low compared to many countries, have seen little improvement in recent years. According to the latest data from the Office for National Statistics (ONS), the maternal mortality rate in the UK stands at around 7.8 deaths per 100,000 live births. Additionally, morbidity rates, including severe maternal morbidity such as obstetric trauma and postpartum haemorrhage, remain an ongoing concern.

Other Trusts recently under scrutiny or placed in special measures are; 

North Devon Ladywell

South Devon and Torbay

Derby and Burton

Nottingham

East Kent

Chichester

Swansea Singleton Hospital

Royal Glamorgan

Birmingham Heartlands

Worcester

Royal Cornwall

Milton Keynes

All three maternity units in Greater Manchester – Saint Mary’s at Oxford Road, Saint Mary’s at Wythenshawe Hospital, and Saint Mary’s at North Manchester General Hospital.

Sheffield Teaching Hospital

Fragmented Efforts to Improve Maternity Care: Recognizing the need for improvement, various initiatives have been introduced to enhance maternity services in the UK. These include increased investment in perinatal mental health services, enhanced training for healthcare professionals, and initiatives to promote safer childbirth practices. Additionally, the NHS Long Term Plan aims to provide personalized maternity care and support continuity of care for women throughout their pregnancy and postpartum period. Yet the CQC still rate 39% of all maternity units as inadequate, their own statistics show a worrying trend of declining standards although examples of good practice and care are evident, they are overshadowed by the poor.

Conclusion: Its sobering reading, and demoralising to work within the pressure cooker of a system that is structured in so many different ways, by so many different Hospitals/Trusts, and then this is based on individual practices, preferences and policies within that organisation.

So one question we want to raise;

Is a national restructure the best option with a one-size -fits- all- Trusts, policy framework, one logical answer to reduce the high rates of stillbirth, trauma and poor outcomes seen recently in the headlines and to promote stability and improve staff recruitment/ retention rates among NHS health workers, including Midwives.