The Birth Trauma Inquiry: ‘Women treated as an inconvenience’

Home » News & Knowledge » The Birth Trauma Inquiry: ‘Women treated as an inconvenience’ on maternity wards, report finds

A parliamentary inquiry into childbirth trauma has called for an overhaul of the UK’s maternity services, after thousands of women shared their devastating experiences of giving birth.

The Birth Trauma inquiry, launched by The All-Party Parliamentary Group heard how there is inconsistent care across the UK for pregnant women during and after their labour which frequently leads to preventable physical and psychological injuries.

More than 1,300 women took part to highlight their traumatic birth experiences, which included women being left in blook-soaked sheets in hospital, and others said their children suffered life-changing injuries due to medical negligence.

Some women said they experienced a lack of kindness and compassion during one of the most vulnerable moments of their lives, and others were denied basic needs such as pain relief.

The Birth Trauma Inquiry

One woman said she experienced heavy bleeding following the birth of her son, and despite calling for help, she was not seen by staff until another mum on the ward came to her aid.

“About 6 hours after [my son] was born, I experienced a heavy bleed. I could see my white hospital bedsheets going red and I thought I was haemorrhaging again. I pressed my bell, nobody came. I pressed it again harder and nobody came.

“Another mum opposite me saw the sheets going red and my distress and went to get somebody. In that moment, I believed I was dying and my baby was going to be there in the hospital alone, with his mother dying next to him and nobody there who loved him or even knew his name. I was terrified,” she said.

Another woman said staff failed to listen to her after reporting concerns about her baby, and was instead thought to be ‘an overly anxious mum.’ She said:

“I was concerned that my baby was looking ‘yellow’ and asked the midwife. She told me I was being overly anxious and he was fine. She wrote in my notes that I was an overly anxious mother and my baby was NOT jaundiced.

“My husband intervened and a doctor confirmed my baby was jaundiced and he was treated. The next day the page written by the midwife had been torn out.”

The report states that in many cases, the trauma was caused by mistakes and failures made before and during labour – and frequently these errors were covered up by hospitals.

Meanwhile, in the past 10 years, there have been three major investigations into failings in maternity care at specific NHS trusts: Morecambe Bay, Shrewsbury and Telford, and East Kent and a fourth is underway at Nottingham University Hospitals.

These reports all led to recommendations to improve maternity care, but a current programme of inspections by the Care Quality Commission (CQC) has resulted in nearly half of maternity units in England being rated as either “inadequate” or “requires improvement”.

Current policy on improving maternity care is fragmented, and although several national policy documents address the need to improve maternity care, the inquiry heard that there is no single overarching strategy document.

The inquiry aimed to investigate the reasons for birth trauma and to develop policy recommendations to reduce the rate of birth trauma in the UK. Some of the recommendations include extending the time limit to make a medical negligence claim from three years to five years to give women more time to seek compensation for the damages.

The All-Party Parliamentary Group on Birth Trauma also calls for a new Maternity Commissioner who will oversee the National Maternity Improvement Strategy and report to the Prime Minister.

The Birth Trauma Inquiry findings

Basic needs denied

Some women said they were denied basic needs such as pain relief and were mocked or shouted at by staff. Issues were also raised about post-natal care and birth injuries causing a ‘lifetime of pain and bowel incontinence’, affecting a woman’s livelihood and working life.

Women frequently felt they were subjected to interventions they had not consented to, and many felt they had not been given enough information to make decisions during birth. The poor quality of postnatal care was an almost universal theme. Women shared stories of being left in blood-stained sheets, or of ringing the bell for help but no one coming.

Poor communication

Many women described a lack of communication and not being told what was happening during labour. Some said they only found out that they had a particular condition when they read their medical notes or had a birth debrief months later.

In other cases, there were unfortunate communication mix-ups. One mother, Heather Simmons, giving oral evidence in session 5, told the inquiry that, after an intensely traumatic birth, in which her baby was taken to the neonatal intensive care unit (NICU) and she was barely able to walk, she was told by the midwife that her blood results showed she had been taking drink and drugs in her pregnancy.

As a result, her daughter was given an HIV test, without Heather’s consent. It was later found that the midwife had been reading from someone else’s notes

Birthing injuries

Some accounts came from women who had experienced birth injuries, causing a lifetime of pain and bowel incontinence. Many of these women said they could no longer work and described their injuries as having destroyed their sense of self-worth. Other women wrote movingly of having to provide round-the-clock care for children left severely disabled as a result of birth injuries.

Women from marginalised groups, particularly those from minoritised ethnic groups, appeared to experience particularly poor care, with some reporting direct and indirect racism.

Mental health services and PTSD

Many women wrote of their difficulty in accessing maternal health services, either facing long waiting lists or being told they didn’t meet the criteria for help. The inquiry states that there is a ‘postcode lottery’ for mental health care, and some women face many barriers to getting the help they need.

The inquiry found some of the reasons for the failed mental healthcare, include a failure on the part of GPs or other health professionals to recognise PTSD symptoms, long waiting lists, or a refusal by services to accept women because they were not ill enough or, in some cases, too ill, or because they were past the cut-off point of one year after birth.

One woman whose baby was stillborn wrote that in the area in which she lives, there was no specialist maternity loss and trauma service:

“The final kick in the teeth after she died and I was feeling intensely suicidal was that the perinatal mental health team wouldn’t take me on because I had no living baby,” she said.

Maternity professionals and recruitment

Some of the issues stem from a lack of midwives, burnt-out staff and a poor working culture within hospitals. The inquiry found that midwives in particular experience high levels of stress due to under-staffing, a poor physical environment and a harmful working culture.

Some found it difficult to see how women were treated in the system: one midwife wrote that she and her colleagues “are witness daily to the devastating impact of poor staffing, poor provision of resources, poor care and poor communication, which result in people lacking confidence in the service and the standard of care they will receive.”

Postnatal care

Poor postnatal care was mentioned in nearly all the personal submissions. On the postnatal ward, women described being left alone, often unable to move after an emergency caesarean or difficult forceps birth, but with no one to help them go to the toilet or lift their baby.

Several women had stories of being left to lie in their blood, urine or excrement, or even berated by midwives for having soiled themselves.

One woman said that after an emergency caesarean, she developed sepsis and was put on an antibiotic drip, restricting her mobility. Her husband was sent home. Her baby, having been taken away and given antibiotics for suspected meningitis, was brought back.

“I was not only expected to try and calm her but also change her as she had been sick and was soiled on arrival. Staff pushed her into the end of the bed, told me to clean the baby up because she’d been sick and was soiled and walked off. I could hear the staff all outside the bay sat at the nurses’ station laughing and planning on ordering a Chinese takeaway before they closed,” she said.

Birth trauma inquiry recommendations

The recommendations laid out in the inquiry include the following. It has also been recommended to appoint a new Maternity Commissioner to oversee the National Maternity Improvement Strategy and report to the Prime Minister.

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.
Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery
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.
Roll out and implement, underpinned by sufficient training, the OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce the risk of injuries in childbirth.
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.
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.
Respect mothers’ choices about giving birth and access to pain relief and keep mothers together with their babies as much as possible.
Provide support for fathers and ensure the nominated birth partner is continuously informed and updated during labour and post-delivery.
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.
Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
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.
NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work

Birthing injuries medical negligence – How to make a claim

Injuries to mothers arise during the pregnancy itself or as a result of child birth. These injuries can be a natural part of having a baby however, some birth injuries are avoidable and take place during labour or delivery.

If you or your child has suffered from an avoidable birthing injury that has been caused by negligence, you may be entitled to compensation.

Causes of birthing injuries

Every mother is entitled to a good standard of antenatal care and your midwife, nurse or Doctor should detect any signs which could lead to a birth injury. Some main causes of maternity injuries include:

Failure to identify the progression of labour
Mismanagement of maternal conditions such as high blood pressure and pre-eclampsia
Decisions about the mode and timing of delivery e.g. should a c-section have been brought forward
Mismanagement of infection e.g. Group B Strep
Surgical errors
Retained Placenta, sometimes resulting in infection

Types of birthing injuries

Birth injuries suffered by mothers are varied. This section deals with some of the most common injuries but not all of them. Please contact the Clinical Negligence department for a member of our specialist team who will sensitively discuss your enquiry.

Vaginal tears

Many women experience vaginal tears during delivery. Sometimes this is a natural consequence of child birth and they quickly heal, however, sometimes these tears are avoidable and are serious which causes a prolonged recovery period and healing time, as well as causing long term effects on the mother.

First degree tears: These are skin-deep and only affect the outermost layer of skin around the vaginal and perineum, These are superficial and will heal on their own.
Second degree tears: These are deeper tears, effecting the muscles of the vagina. Stitches are normally required to help the tear heal. These are usually painful and will recovery within a few weeks. Your midwife will examine the tear time to time to ensure good healing
Third and fourth degree tears: These are the most serious tears which are deeper, they affect the skin, tissue and muscles extending to the anal sphincter. These require careful surgical repair.

Uterine prolapse

A prolapse of the uterus happens when the uterus slips down in to the vaginal canal. This is as a result of a women’s pelvic organs bulging in to the vagina or pelvic floor muscles and ligaments have stretched and weakened during child birth.

A prolapse of the uterus is more likely in cases where women have endured a particularly long, traumatic or difficult labour. Women who have a larger baby are also at more risk of a uterus prolapse. Symptoms of a uterine prolapse include:

Urinary incontinence
Pain during sexual intercourse
A sensation of heaviness in the vaginal or pelvic area

Those who have experienced a uterine prolapse may require invasive treatment dependant on the severity, such as a hysterectomy, this involves the removal of the womb meaning a women cannot have any more children. However, sometimes it requires the surgical repair of the pelvic floor muscles.

Post-Natal depression (PND) and post-traumatic stress disorder (PTSD)

Birthing injuries to women can not only be physical but also affect them mentally. A negative or par5ticularly stressful experience before, during or shortly after childbirth can cause a negative impact on a women’s mental health and well-being. Experiences during birth affect everyone differently and are highly sensitive, common signs include:

Difficulty bonding with their baby
Difficulty with sleeping
A feeling of guilt and isolation
A feeling of exhaustion and hopelessness
The feeling of ‘failure’, and that the events of a baby’s birth was their own fault

Many women will suffer silently and not seek help with PND and PTSD. However, it is a common effect of birth with 3 in 10 new mothers experiencing PND or PTSD. These are serious injuries and require the correct treatment.

If your child has suffered injuries at childbirth due to negligence you may also be entitled to make a claim.

How long do I have to make a claim?

Claims of this nature are subject to a three-year limitation period. This means that claims have to be commenced within the courts in three years of either the date the negligent act occurred or the date you became aware that negligence had occurred.

In cases involving deceased victims this limitation period commences from the date of death and in cases involving minors, the limitation period starts when they reach their 18th Birthday.

The law surrounding limitation periods is complex, our specialist team will be able to advise further.

The Birth Trauma Inquiry: ‘Women treated as an inconvenience’ on maternity wards, report finds