Straight to the point

One of the riskiest things you can do in an NHS hospital is have a baby. Two thirds of NHS maternity units are not “safe enough” for women giving birth, according to the Care Quality Commission, while a quarter deliver “a high risk of avoidable harm to mother or baby”. But poor maternity care is nothing new: the past decades are littered with examples of scandals and promises of “never again”.

I was three months pregnant, in March 2022, when midwife Donna Ockenden’s government-commissioned report was published, detailing the extreme failings in maternity care in Shrewsbury and Telford. Thinking about giving birth in these circumstances was more than a little nerve-wracking. 

For many women, pregnancy and childbirth is a means to an end — something you have to do to get the baby you and your family so desire. And yet, a picture is being painted in the NHS of a custom-made journey of self-discovery that allows women to realise their true biological and spiritual potential. I remember an appointment, late in pregnancy — when I was trying to keep the weight off my swollen ankles — during which I was asked by my midwife whether I had filled out the playlist requirements in my NHS-issued birth plan (the “blue book”). It is only now, a year later, that the contrast between this moment and the reality of the neglect I suffered during my son’s actual birth can raise a hollow laugh.

Few investigations into the UK’s dire maternity care seem to want to explore the emergence of a natural or holistic ideal. Most focus on funding and staffing — which almost everyone agrees the NHS is lacking. But in every scandal, the same problems arise: delayed interventions for babies with low oxygen or slow heart rates, caesarean sections being refused and women’s concerns being ignored.

For many of those women whose children have died, poor funding or staff morale were not the cause. “Beatrice died with three midwives and two doctors in the room,” the interminably brave Emily Barley tells me. “There was not a lack of staffing, that was not the problem. The cultural issues, the attitude issues, the lack of leadership — these are way more important.” Beatrice died in May 2022 due to medical negligence after staff at Barnsley Hospital failed to monitor her heart rate and missed signs that she was in danger. Like many of the mothers and babies who have lost their lives to poor maternity care, Beatrice’s death was wholly avoidable — proper and timely medical intervention would have delivered her safely into Emily’s arms.

These appalling fatalities only tell part of the maternity care horror story. There are all those children born with serious brain injuries due to complications in long labour, or the women left with severe injuries which are rarely reported. I had the good fortune to leave with a healthy baby after an unjustifiably terrible ordeal and women like me often clam up — partly not wanting to relive the trauma, partly from guilt at not feeling joyful during those first few days of a child’s life. Perhaps worse than being denied pain relief, left in soiled sheets and ignored by midwives was the shame I felt for having not enjoyed the experience. Photos of his arrival show me pushing him away. For months, midwives had lectured about how beautiful, wonderful and natural this moment would be; how I would bond with him during skin-to-skin contact and breast-feed him immediately. Those words rang in my ears as I realised my first meeting with him — after surgery and a haemorrhage — would be one of nausea and pain.

But unlike our mothers and grandmothers, those of us giving birth today have Twitter, where an informal group of women digging into the background of NHS policy and practices have become something of a lighthouse in the storm of maternity scandals. “I have the receipts,” maternity safety campaigner Catherine Roy tells me, describing how care has been shaped and influenced by a push towards “natural” childbirth. Her feed is full of the “complimentary therapies” offered during childbirth in NHS trusts: things such as “sterile water injections” for pain relief or “mindful relaxation techniques” such as hypnobirthing for £30 a pop. She points out that such practices are no longer kept to the fringes. Staff working at Nottingham’s Queen’s Medical Centre and City Hospital’s maternity departments, both mired in scandal, were found to have “been using aromatherapy to treat infections, ‘hysteria’ and help prevent labour complications”.

How did we get here? How has it become acceptable for women to be neglected during labour, refused pain relief, and to be encouraged to delay — or even be denied — medical intervention? Throughout the mid to late-20th century, feminist movements interested in reclaiming women’s bodies began to have influence on midwifery. Books such as Our Bodies, Ourselves (1970) sought to challenge a sexist culture by encouraging women to take ownership of their bodies’ functions. This was an era when unnecessary interventions — from shaving to enemas — were common in maternity care, making many women feel like livestock instead of mothers. But the new emphasis on women’s bodily autonomy also began to view childbirth as a part of women’s identity — and, as such, something that should be entirely dictated by a woman’s natural processes. 

Catherine tells me that, in the Nineties, the views of non-medical organisations such as the National Childbirth Trust (NCT) were given almost as much weight as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. The idea that “pregnancy was not an illness” and therefore didn’t necessarily require medical intervention, became prevalent. Targets for vaginal (or “natural”) childbirth rates were introduced. Much like the recent furore over NHS guidelines being tweaked by external organisations such as Stonewall, part of the ethos of maternity care has been shaped by external organisations with their own agendas and views of how women should be treated. As such, the idea of having a baby as a means to an end diminished, and the view of childbirth as an authentic experience for women at home, free from interfering doctors, proliferated.

Worse still, this move towards a hands-off approach was at least partly the result of a cold, cost-benefit analysis by the National Institute of Health and Care Excellence (NICE) in the early 2000s. A remarkable document from the Parliamentary Office of Science and Technology in 2002 discusses the problem of high caesarean rates, stating that women requesting c-sections are “unlikely to be determined simply on the basis of ethics and evidence, but is also a question of resources and cost effectiveness”. The same document notes how some hospitals have a “culture that takes pride in low CS rates”. It seems that a cash-strapped NHS had allowed a “nature-knows-best” approach to flourish in order to conceal their inability to meet the needs of women’s medical care. 

What has not changed is the fact that childbirth is often unpredictable and complicated. Women who sail through pregnancy with no problems can swiftly find themselves in life-or-death situations. Mary (not her real name) had expected a normal birth after a healthy pregnancy, but developed sepsis and complications as her daughter’s heart rate dipped. Eventually, after being unable to provide an epidural because of the sepsis and unable to monitor the baby’s heart rate properly, staff approached Mary with a choice. “They told me we can give you the option of having an emergency section, or wait an hour just to see how it goes,” she tells me. “But why give me the option to go for an emergency section? Why would I risk waiting? It confused me, I was worried — is it an emergency, or isn’t it?” Hopped up on gas and air, after hours of painful labour, Mary was asked to make a decision that could mean life or death for her baby — a decision that staff should have had the authority to make.

The NHS “fell in love with a certain idea, that birth could be this beautiful, peaceful experience”, Ruth Ann Harper from the Infant Feeding Alliance tells me. “If you breathe your baby into the world, there will be oxytocin and perfect bonding, you’ll breastfeed with ease, create a perfect microbiome, tackle poverty and be an activist against unethical practices by the formula industry in developing countries,” she says. “All of that is a very enticing fantasy — but it’s nothing more than a fantasy.” 

Harper, along with Sue Haddon, set up the feeding organisation to challenge thinking around a breast-is-best mentality. They believe that overcomplicated, overbearing medical advice — such as how to “bond” with your child after birth — has been forced on women when it is unnecessary. In contrast, what should be the realm of medical expertise (such as delivering a baby safely) seems to be focused on natural processes. “I respect women who want lavender oil and home births and want to breastfeed well into childhood — do whatever you like,” says Harper. “But that does not mean the NHS needs to produce a leaflet about it and change what it knows to be true — that quite a lot of us have complications and need help.” 

In some ways, not much has changed for women giving birth. My mother tells a story of midwives in the hospital laughing at her for asking for the TENS machine — an instrument which did little more than tickle her back. But from hypnobirthing to antenatal classes and breathing techniques, Catherine argues that a focus on “natural childbirth” has become the norm, while “giving pharmaceutical pain relief to women” is seen as a failure — what she describes as “a denial that childbirth is painful”. 

For Professor Ellie Lee, director of the Centre for Parenting Culture Studies at the University of Kent, part of the problem is that women have been told birth has to be “meaningful, that it has to say something about who you are as a woman”. This pressure on women, to brave it out on their own, reflects a wider change in relations between patients and the NHS, she tells me. “There has also been a shift towards embracing alternative medicines, and a belief that if we do the right things for our bodies, our bodies should be able to do the right thing for us.”

As a result, we have ended up with a maternity system that seems to think doing very little for women and their babies is the preferable form of treatment. And while there is nothing wrong with wanting a natural childbirth, this is difficult territory. For not only are we risking women and babies’ lives by pretending that childbirth is not dangerous, but we are also failing women in the most basic aspects of care and common sense. For Sue, whose daughter was hospitalised with serious problems, including dehydration, after she was told not to supplement her milk supply for fear of affecting her ability to breastfeed, the needless harm of poor care cannot continue. “I know that I’m one of the lucky ones. I know that there can be more devastating harms than this. And I know that if that had happened, I wouldn’t be here talking about it.”

The baby groups and stay-and-plays I have attended are full of women whispering similar stories of mistreatment to one another, vowing not to return to that hospital again. But for maternity staff to rediscover their medical authority, and do what they were trained to do — deliver healthy babies and keep mother’s safe — more of us have to speak up and prove that this fetishisation of a “natural” fantasy was not done with our consent. 

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