Pregnant women are being treated like a ‘slab of ‘meat, a damning report into the ‘postcode lottery’ of NHS maternity care ruled today.
The UK’s first parliamentary inquiry into birth trauma has found there is ‘shockingly poor quality’ in maternity services, claiming good care is ‘the exception rather than the rule’.
It heard evidence from more than 1,300 women, including new mothers who’d been left to lie in blood covered sheets for hours and even berated by midwives for having soiled themselves.
One woman carrying twins who went into premature labour at 19 weeks was told by a consultant to ‘stop stressing’ after she lost her first baby. Another, dismissed as an ‘anxious mother’, later lost her baby from complications she warned about.
The scathing report comes after ex-Made in Chelsea star Louise Thompson revealed how she feared she would die after she was refused a C-section, lost three-and-a-half litres of blood and tore her womb when giving birth to son Leo.
In an exclusive extract from her book published by Mail+, the 34-year-old confessed she could barely look at her baby after his traumatic birth and her fiancé Ryan Libbey thought about leaving her.
Health Secretary Victoria Atkins labelled testimonies heard in the report ‘harrowing’ and vowed to improve maternity care for ‘women throughout pregnancy, birth and the critical months that follow’.
It comes just a day after former Made in Chelsea star Louise Thompson revealed how she thought she would die after she was refused a C-section, lost three and a half litres of blood and tore her womb when giving birth to son Leo
The 34-year-old endured an agonising labour which saw her lose three-and-a-half litres of blood in three hours as she welcomed her son Leo. In an exert of her new book ‘Lucky: Learning to Live Again’, published in the Mail on Sunday, she recounted how she could ‘see immense amounts of my blood splattering all over the curtain’ and ‘splashing on to the floor below’ as she was rushed for an emergency C-section
NHS England chief executive Amanda Pritchard also said the experiences outlined in the report ‘are simply not good enough’.
The all-party inquiry was led by Conservative MP Theo Clarke and Labour MP Rosie Duffield.
The report found ‘poor care is all frequently tolerated as normal, and women are treated as an inconvenience’.
Among its 12 recommendations included the creation of a maternity commissioner reporting to the Prime Minister.
Other key suggestions are to digitise mother’s health records and ‘provide support for fathers and ensure [a] nominated birth partner is continuously informed and updated during labour and post-delivery’.
Ms Clarke, who pushed for the inquiry after revealing in Parliament that she felt she was going to die after giving birth in 2022, told The Times: ‘We have listened to mums carefully and applaud their bravery in coming forward, sometimes with horrific testimony of how the system failed them and the mental, physical and economic cost of that failure.
‘The raft of recommendations we make, especially the appointment of a maternity commissioner, are all designed to end the postcode lottery on maternity services.’
The report detailed how one woman who suffered bowel problems after a traumatic birth and took her hospital to a tribunal for neglect after problems during labour was told by a doctor ‘why don’t I just a stick an anal plug in and get on with my day’.
Another described how her severe physical symptoms from birth trauma, including fatigue and tremors, were wrongly diagnosed as psychological, leading her to receive eight sessions of electroconvulsive therapy, which involves sending an electrical current through the brain.
One woman carrying twins went into premature labour at 19 weeks and lost her first baby.
‘I was told by one of the consultants to stop my crying, calm down and try to save the other baby,’ she told the report.
‘His words were: “This baby was dead a long time anyway so you should stop stressing over it and let’s try to save the other one”,’ she said.
The second baby also died.
Ms Atkins said she was ‘determined to improve the quality and consistency of care for women throughout pregnancy, birth and the critical months that follow’.
She added: ‘I am hugely grateful to Theo Clarke for her carefully considered report and all those brave women who came forward to share their harrowing experiences.’
The all-party inquiry, led by Conservative MP Theo Clarke and Labour MP Rosie Duffield, is due to publish its findings on Monday. According to The Times, the report found ‘poor care is all frequently tolerated as normal, and women are treated as an inconvenience’
Ms Clarke, who pushed for the inquiry after revealing in Parliament that she felt she was going to die after giving birth in 2022, told The Times: ‘We have listened to mums carefully and applaud their bravery in coming forward, sometimes with horrific testimony of how the system failed them and the mental, physical and economic cost of that failure’
Earlier this year in January, the health secretary shared her personal experience of the ‘darker corners’ of the NHS after giving birth to her son in 2011 as a patient with type one diabetes.
Complications at the end of her pregnancy left her sharing a ward with new mothers who suffered ‘hellish agony’ and birth trauma.
At the time she pledged to make women’s health a ‘top priority’ so that other women ‘would not face the fear that I faced’.
Responding to the report today, Liberal Democrat MP and co-chair of the all party parliamentary group on baby loss, Helen Morgan, said: ‘This inquiry has exposed what many of us have long feared about the state of the country’s maternity services.
‘For so many women to have such traumatic experiences of birth is nothing short of a national tragedy. Too many are being failed in pregnancy, birth and aftercare as this report shows.
‘It’s time the Government took action to end the postcode lottery in maternity services. I urge them to accept the report in full.’
Asked whether there was an apology to be made, women’s health minister Maria Caulfield told Sky News: ‘Absolutely. I recognise as women’s health minister that maternity services have not been where we want them to be.’
But she added the Government is already doing much of the work recommended in the report.
She told Times Radio: ‘We absolutely recognise what’s in the report. We are on track with rolling out some of these services to prevent this from happening in the first place but, when it does, better look after women.’
It comes as former Louise Thompson yesterday revealed the truth behind her traumatic childbirth at NHS Chelsea and Westminster hospital, for first time.
In an exert of her new book ‘Lucky: Learning to Live Again’, published in the Mail on Sunday, the 34-year-old recounted how she was repeatedly refused a C-section despite feeling she was too small at 5ft and with a 6ft 3 partner to give birth naturally.
Doctors eventually ordered a C-section after it was found Leo’s head was stuck in her pelvis.
Unbeknown to her at the time this had actually tore her womb, leading to bleeding that was hard to stop and led to her losing three-and-a-half litres of blood, more than three quarters of the blood in the body.
She said she could ‘see immense amounts of my blood splattering all over the curtain’ and ‘splashing on to the floor below’.
She added: ‘No one gave us any reassurance; it was all like some sick nightmare.
‘Everyone in the room looked very distressed, I could feel their shaky hands on my body. If they’d allowed me to have a planned C-section, things could have been very different.’
The Birth Trauma Association charity says an estimated 20,000 women a year develop post-natal post traumatic stress disorder, and that as many as 200,000 women may also feel traumatised by childbirth and develop some of the symptoms of PTSD.
About 65 per cent of the NHS’s budget to cover clinical negligence claims — which totalled £69.3billion in 2022-23 — related to maternity and neonatal liabilities.
One woman, who was awarded damages after her twins were born, told the all-party inquiry how she felt she was treated like a ‘birthing vessel’ and ‘slab of meat’ by Britain’s maternity system.
Rachael McGrath, from Cheshire, believed she was bleeding to death when she was taken to hospital with an abrupted placenta.
Her twins were born requiring resuscitation and survived, but ‘impersonal’ care and being met with what she felt was sarcasm or hostility when asking for help left her traumatised.
she went into renal failure after her twins were delivered by caesarean section, and five days after the birth, the scar from the surgery completely disintegrated.
‘Nobody treated the fact that my insides were now on the outside,’ she said.
‘They stuck a sanitary towel over my abdomen and left me there for ten days until eventually I became gravely ill again.’
In her evidence Ms McGrath, who is now chairwoman of the Birth Trauma Association, said: ‘I would have somebody holding a blood pressure cuff taking my blood pressure and on their phone giggling and texting with the other hand.
‘I was in for such a long time and some of the staff would come and get in my room and talk about other patients unkindly and talk about other staff members unkindly.’
Rachael McGrath, from Cheshire, believed she was bleeding to death when she was taken to hospital with an abrupted placenta. Her twins were born requiring resuscitation and survived, but ‘impersonal’ care and being met with what she felt was sarcasm or hostility when asking for help left her traumatised
Divina Johnson, from Erdington in Birmingham, today also told how she though she was ‘going to die’ giving birth on the NHS.
The mum-of-three from Erdington in Birmingham, had a normal first pregnancy and assumed when her waters broke at 41 weeks in 2016, that labour would be the same.
Instead, it was the ‘most terrifying experience’ of her life after a nurse wrongly administered an epidural and she was berated by midwives.
She also claimed she felt reduced to a ‘vessel that had a baby’.
She told ITV’s Good Morning Britain: ‘I thought I was going to die. I had an epidural done incorrectly by an anesthetist who was over her shift.’
‘She then laughed at me when I was in the foetal position and couldn’t move and said “people don’t normally act that way when I give them an epidural”.’
After it was removed, the pain ‘immediately went away which let me know that something had gone wrong’, she added.
After nearly two days in labour, she was given a caesarean section.
‘After my C-section in the recovery, the midwife just pulled my gown down and said “your baby hasn’t eaten for hours, you need to start breastfeeding”. And just put her on.
‘It continued that way, having really awful care — if you could call it care.’
The report’s publication also follows a litany of maternity failures including Shrewsbury and Telford and East Kent NHS Trusts, with a record number of services now failing to meet safety standards.
The Care Quality Commission (CQC) found some 65 per cent are now rated ‘inadequate’ or ‘require improvement’ for safety.
Frontline midwives have previously warned working in the NHS is like playing a ‘warped game of Russian Roulette’, as there was a risk of harm or death at any time, partly due to ‘dangerously’ low staffing levels.
The CQC’s annual maternity survey, published in February, revealed women’s experiences of care have deteriorated in the past five years, with staff shortages a key reason.
The Royal College of Midwives suggests staff shortages and lack of funding is making it harder for midwives to deliver better-quality services.
The RCM’s latest calculation is that England is short of 2,500 midwives.
Divina Johnson, from Erdington in Birmingham, today also told how she though she was ‘going to die’ giving birth on the NHS. The mum-of-three from Erdington in Birmingham, had a normal first pregnancy and assumed when her waters broke at 41 weeks in 2016, that labour would be the same. Instead, it was the ‘most terrifying experience’ of her life after a nurse wrongly administered an epidural and she was berated by midwives
Katie Wilkins’ baby girl Maddison was stillborn in February 2013 at Royal Shrewsbury Hospital after midwives left her in a side room for 48 hours and failed to properly monitor her. A March 2022 probe into Shrewsbury and Telford NHS Trust found that 300 babies had died or been left brain-damaged due to ‘repeated errors in care’
Sarah and Tom Richford with their son Harry who died seven days after he was born in November 2017 at the Queen Elizabeth the Queen Mother Hospital in Margate. East Kent Hospitals admitted failing to provide safe care for the mother and baby and was fined £733,000 in 2021. A 2022 probe into the trust revealed dozens of babies and mothers died or were injured during childbirth
Some 201 babies and nine mothers died needlessly during a two-decade spell at Shrewsbury and Telford Hospital NHS Trust.
In a landmark 250-page report, investigators who probed the failures cited an obsession with ‘normal births’.
Women were encouraged to have vaginal deliveries, often when a caesarean would have been a safer option, to keep surgery rates low.
A similar scandal at Morecambe Bay NHS trust also referenced the dangers of fixating on natural or ‘normal’ births.
The 2015 inquiry, which found 11 babies and one mother suffered avoidable deaths, ruled a group of midwives overzealously pursued natural childbirth and that ‘led at times to inappropriate and unsafe care’.
Katie Wilkins’ baby girl died at Shrewsbury Hospital after midwives left her in a side room for 48 hours and failed to properly monitor her.
Miss Wilkins was 15 days overdue when she arrived at the hospital to be induced in February 2013.
There were no beds available on the busy labour ward and Miss Wilkins, claimed she was ‘forgotten’ in the room for two days and visited by staff just a handful of times.
When a midwife did come to check on her progress they realised her baby’s heartbeat could not be found. Maddie was delivered stillborn in the early hours of the following day.
Hospital bosses later admitted the baby would have been born alive had they treated her in a more ‘timely’ manner.
Donna Ockenden, the senior midwife asked by the government and NHS England to investigate serious maternity scandals including Shrewsbury and Telford Hospitals NHS Trust, today backed Ms Clarke’s inquiry.
She said the report ‘highlights the extent of the problem we know exists across maternity services in the UK’
She added she had given the government a ‘clear blueprint and roadmap’ for maternity services but ‘progress has been far too slow’.
