Improving Maternity Care

Kaitlin Dryburgh

The findings of the first UK inquiry into birth trauma has produced some gritty and troublesome reading. Hearing the harrowing accounts of over 1,300 women paints a picture of maternity care which is well below the standard we would want.

It is now estimated that close to 30,000 women per year in the UK have suffered a negative experience when giving birth. This included anything from women’s concerns being dismissed, being berated for asking for pain medication, ignored, lied to, and being treated with very little kindness when going through a particularly sad birthing experience. Due to this one-in-20 have developed post-traumatic-stress-disorder, and for the very few their experience follows them for decades to come.

The report highlights the very worst cases that plague our health service, professional misconduct, and fireable offences. Yet, trying to apply the “it’s just a few bad apples that ruin it for the rest” theory doesn’t quite work here. There is an undercurrent theme of poor care being continuously excepted and excused. Although individual decisions from healthcare professionals have been one of the causes, in many cases it’s simply the lack of staff on maternity wards that don’t allow for adequate medical care to be provided. In many cases the level of care is standard and widely accepted as being the norm.

Unfortunately, there continues to be a poorer standard of care for women of ethnic minorities and some noted experiencing both direct and in-direct racism. This however isn’t a complete revelation as we knew before this report that black women for example are at four times greater risk of maternal mortality than white women. Poor maternity care for ethnic minority women has been widely known for years, yet there doesn’t seem to be a concerted effort to overcome this damming fact.

What has become an overwhelming truth is the “postcode lottery of care”, specialist maternal services including mental health services are not readily available to everyone. One women whose baby was stillborn was told she was unable to access specialist maternity loss and trauma service in her area. If her child had survived and she was suffering from post-partum depression, this would have been a different story and she would have been able to access services.  The inquiry brought about some substantial recommendations. From recruiting and training more midwives, obstetricians, and anaesthetists, the roll-out of standardised post birth services, more checks, better education for women on birth choices and better training for staff, as well as a dedicated maternity commissioner and better support for fathers, this was an issue continuously highlighted through-out the process. The recommendations vary in the time it would take to implement but could provide a solid solution to the problems laid out by the inquiry. However, some of the problems occurred are a result of much bigger problem that effects the NHS as a whole. Under-funding and poor management.

Maternity services are not immune to the top-heavy management styles which see an over use of non-medically trained managers making decisions which are at odds with the medical professionals in the hope they’ll make a quick saving here and there.

Maternity research is also a victim of woeful underfunding, particularly post-natal care. It on the whole doesn’t attract much medical research interest explains Professor Julia Sanders, Health and Care Research Wales Specialty Lead for Reproductive Health and Childbirth. In 2021 Sanders went on to explain that research has often stopped short of investigating the health of women after giving birth, the thought process has always been they’ve gone home in tact with a healthy baby, the job is done. Yet the effects of giving birth to both the physical and mental state is often over-looked, something that we are only now beginning to recognise. Overall women’s health is more unknown than men, before 1993 women were rarely included in medical studies. This has contributed to a history of under-researching and playing catch-up.

The postcode lottery of maternity care can affect anyone, however the likelihood of receiving patchy care is heightened when you consider living remotely. Although this report was looking at the UK as a whole, Scotland’s greater rural and remote communities makes it more susceptible to inequality and poor access across maternity care. In Southern-Western Scotland some women are having to make 140-mile roundtrips to give birth, this has resulted in some being forced to give birth in lay-bys. This is not the expected level of care and infrastructure you would envision for a developed nation. In this area of Scotland women are having to drive to Dumfries and Galloway Royal Infirmary. Up until 2018 women with low-risk pregnancies were able to give birth in a community unit in Stranraer, but this was closed down.

In the far North of Scotland mothers and their babies are more at risk since the Caithness General maternity unit in Wick was downgraded in 2015 from consultant lead to midwife lead. This means that only those deemed to have extremely low-risk pregnancies will be delivered there. Anyone deemed to be a high-risk or with any complications will have to make the 100-mile trip to Raigmore hospital in Inverness, and even then specialist cases may be moved to Aberdeen or even Glasgow. That's the equivalent of a women in Edinburgh being told she needs to travel to Newcastle.

This meant that in 2022 only eight babies were delivered in Wick. In 2015 before the downgrade it was 160.

Data also showed that only 28 of transfers were completed by ambulance, the majority were using their own transport. Overall 90% of mothers are having to make the 100-mile trip to Inverness. The heightened risk and anxiety in some cases are unimaginable, especially when you take into account the weather this area can experience, which campaigners believe hasn’t been properly considered.

Plans to update the Raigmore hospital have been approved but little has been done to answer campaigners who believe that this move, although good in many aspects, means a focus on continuing the long journey many women have to make.

There are examples all over Scotland of long journeys and local units shutting-down due to understaffing. Although it would be very much welcomed if Scotland was able to implement all the recommendations set-out in the birth trauma inquiry, this will be nearly impossible without a concerted effort to address the shortfalls in rural health, maternity or not. A centre for rural and remote health and care was established last October, so we will wait to see the influence this centre will bring, especially since the Chair of the British Medical Association in Scotland has claimed rural healthcare services are in crisis. Dr Ian Kennedy has called for a medical training facility to be established in the Highlands to address the biggest problem, under-staffing.