Maternity care failings: forty percent of NHS maternity wards falling below safety standards

The Shrewsbury and Telford investigation has exposed the worst maternity scandal in NHS history. In a twenty-year period of systemic maternity failings, 1,592 women and babies either died, were left disabled, or were traumatised. The review found that the deaths of 201 babies and nine mothers could have been prevented if the Trust had provided better care.

But worryingly, SaTH is not the only bad apple. Deep rooted issues have been prevalent within maternity care for decades. At the core of this are a multitude of failures within management and leadership, as well as obstetric teams, in pursuing learning and improvement from past mistakes.

As clinical negligence specialists, we see too often the catastrophic and life-changing devastation of families who have experienced maternity medical errors, many of which could have been prevented.

The impact on the lives of families and loved ones is profound and permanent. Investigations such as the Ockenden review can cause parents who have experienced maternity failings additional distress as they’re made to revisit trauma and grief they’ve carried with them for years.

While retrospective reports do bring about change, the priority should be on preventing failings happening in the first place. It should not be the responsibility of parents raising their voices to prevent others going through the same experiences.

Forty percent of maternity wards falling below safety standards

A separate report has found that two in five maternity wards are potentially unsafe. Out of 193 NHS maternity wards in England, 80 have been rated by health watchdog Care Quality Commission (CQC) as inadequate or requires improvement. Only two were rated as outstanding for safety.

Large NHS trusts like Sheffield Teaching Hospitals have repeatedly failed to address concerns for safety of mothers and babies despite previous warnings by the CQC. Maternity care investigations are currently underway in Nottingham and Kent.

Safe and high quality maternity care should be the minimum expectation for women and babies. However, obstetrics continues to be the highest value of all clinical negligence claims made against the NHS. In 2020/21, 59 percent of the total value of all new claims was for obstetrics pay-outs – almost £4.2bn.  

Women and their babies continue to be let down by medical staff from pregnancy through to postnatal care. Failures within maternity care can lead to babies being stillborn, having brain injuries as a result of being starved of oxygen, and having broken bones or skull fractures due to excessive force used in delivery.

Prevalent issues affecting maternity care:

• Failure to monitor foetal growth
• Failure to respond to abnormal foetal heart rate
• Failed antenatal screenings
• Improper management of multiple pregnancies
• Failure to treat infections such as Group B Strep
• Failure to escalate any concerns
• Inappropriate use of forceps or ventouse
• Mismanagement of labour and delivery leading to maternal injuries such as fourth degree tears, or worse.
• Poor working relationships and lack of collaboration between staff
• Leadership failing to manage risks effectively
• Failure to listen to patients

Championing ‘normal’ births at all costs

One of the most concerning failures is that women have been denied caesarean sections and instead pushed to give birth naturally, regardless of any risks to their health or that of their unborn child.

A common cause of birth-related injuries is a delayed or prolonged birth, that being active labour that lasts over 18 hours. The longer the baby is in the birth canal, the more pressure within the brain increases, raising the risk of strokes, oxygen deprivation, and brain bleeds.

For almost ten years, the Royal College of Midwives, along with many NHS trusts, peddled a campaign for ‘normal’ births – often at all costs.

Medical intervention and caesarean sections were to be seen as the final resort in place of a ‘wait and see’ or ‘trust your intuition’ approach. Yet a woman’s own intuition that she needed additional help to safely deliver her baby would often be ignored or dismissed in order to keep c-section rates low. The trusts with the lowest caesarean rates were hailed by health chiefs, using surgery statistics by means of performance management.

This dangerous language was abandoned in 2017 and the current head of the RCM has apologised with regret for the ideological childbirth culture it played a part in creating and promoting. However, in 2020/21, there were still five NHS trusts that had c-section rates at less than 25 percent of all registered births: Bradford, Cornwall, Lancashire, Suffolk and South Tyneside.

There is no doubt this obsession with vaginal births seeped beyond the hospital walls.

How many times do we hear the phrase ‘women do this every day’? Or if you had a c-section, that you didn’t give birth ‘properly’. Job specs for midwives at five NHS trusts are still using terminology like ‘championing normality’ for prospective candidates. What exactly is this ‘normal’ birth we regard as the gold standard? In our experience, all women have different birth stories. Childbirth is unpredictable. Smooth sailing pregnancies can be thrown into chaos and uncertainty during labour. But it is how midwives and maternity care teams react to those unprecedented events that will save the lives of mothers and their babies.

Maternity recruitment and retention crisis impacting safety levels

In her report, Donna Ockenden called for a new blueprint for maternity care to overhaul current processes and systems. She proposed 15 immediate and essential steps for every NHS maternity ward, based around better training and better communication with parents.

Staffing issues have been found to be a major contributor to patient safety concerns. Maternity care is in the midst of a recruitment and retention crisis. There is a shortage of 2,000 midwives, on top of the almost 400 midwives who have left the profession in the last year. Scarcity of staff results in an overworked workforce spread too thinly across maternity wards, meaning they simply cannot meet clinical standards, resulting in unsafe practices and care.

Midwives need proper support in order to provide an acceptable standard of care. The government recently announced a funding boost of £127m for maternity services, including £50m to increase staffing levels over the next two years.

Another issue highlighted is the management of patient safety. Any safety improvements already made have often been too slow off the mark. Patients and their families have been denied involvement in investigations. There are also inadequacies with the complaints process. Alarmingly, Sheffield’s safety levels have reportedly deteriorated even further in the six months since the CQC made an unannounced visit last year.

Women need autonomy to make informed decisions in their maternity care

Too often women have been made to feel weak or to blame for not standing up for themselves during labour. Their experiences have been undermined by uncaring and thoughtless remarks from staff. Some women were even blamed for the death of their babies – and their own.

It is a mother’s body and she should get full information so she can choose. Patients have the right to challenge any medical suggestions or demand what they feel they need to keep themselves and their babies safe. Midwifery and obstetrics teams should ensure all women in their care are fully aware of the risks and benefits of all delivery methods so that they can make a fully informed choice when planning a birth.

Amongst the many birth injury negligence claims we have handled, some mothers were not aware that what happened to them or their baby was preventable. This means they may not have initially complained if their experience fell below expected standards. Only with clarity some time later do many women begin to realise that injuries or death could have been avoided.

As previously highlighted, obstetrics is the highest value of all clinical negligence claims and this litigation is said to place a strain on the NHS. However, without investigations and litigation there would be far less incentive for change.