Before the advent of modern medicine, the dangers of childbirth were neatly summed up by anecdotal evidence (of admittedly obscure provenance) claiming that, in medieval times, more women died in childbirth than men on the battlefield, and up to half of all children died in infancy.
Fast forward to the twenty first century and the Royal College of Midwives’ (RCM) ‘Campaign for Normal Birth’ was seen by some as an attempt to turn the clock back to a time when giving birth was a game of chance. That campaign has recently been abandoned because the RCM claimed it made those women who had to have medical intervention feel inadequate - and not, as others claimed, because the policy was intrinsically unsafe.
Medical advances should be embraced
For those campaigning for better maternity care, particularly in the wake of tragedies such as those at Morecambe Bay NHS Trust and Shrewsbury and Telford NHS Trust where a total of 18 babies died unnecessarily, the abandonment of the campaign is a tacit acknowledgment that actively encouraging women to eschew medical intervention is wrongheaded. In every other area of healthcare, the advance in medical knowledge and technology has been welcomed rather than avoided. It is certainly true that giving birth is not akin to an illness but, by the same token, just because it is a ‘natural’ event does not make it intrinsically safe (as women with little or no access to modern healthcare will attest). Medical negligence claims for birth-related injuries and neonatal deaths continue to rise both in number and value, not only putting a price on tragedy but also underlining how far we still have to go in the battle to reduce the number of stillbirths and neonatal deaths.
Every Baby Counts
The drive to improve maternity care is embodied in the Royal College of Obstetricians & Gynaecologists (RCOG) ‘Every Baby Counts’ investigation: it recently reported its 2015 findings into the avoidable deaths and birth-related injuries of 1136 babies nationwide. The report highlighted the contributory clinical and human factors leading to these tragedies and recommended how they can be resolved. Many of these recommendations are already being tackled through initiatives such as the RCM’s ‘Caring for You’ charter. This aims to improve the experience and safety of giving birth by making sure maternity wards are properly staffed and that staff are properly supported. Although over two thirds of NHS Trusts have signed up to the five principles enshrined in the charter, others are still struggling to provide the necessary level of support and training to ensure that tragedies like those at Morecambe Bay and Shrewsbury are not repeated. Indeed, while investigating the causes of neonatal death and injury for the ‘Every Baby Counts’ report, the RCOG found that 25% of Trusts’ information relating to those cases was so inadequate it could not be used.
It comes back to staff shortages
Fundamentally, the NHS needs more midwives – working in partnership with obstetricians – to manage the rising birth rate safely. Unfortunately this continues to be a moving target as the RCM reports an 8% fall in the number of student midwives embarking on a degree course. With greater numbers of midwives approaching retirement, and the government’s immigration policy in disarray, the current shortfall is unlikely to be bridged any time soon. For now, less zealous adhesion to the principle of a ‘normal’ birth (although it has not been entirely banished having been subsumed into the RCM’s ‘Better Births’ campaign as ‘physiological’ birth) and more collaborative working can only help to improve the safe delivery of women and their babies.
Own up to mistakes at the outset
It is impossible to make childbirth entirely risk-free but the maternity ward should be an ideology-free zone. There is a reason why most women can look forward to giving birth with hope rather than fear and that is because medical intervention is on hand to save lives if things go wrong. But when things do go wrong, hospitals need to own up to mistakes at the outset and endeavour to give the families a full explanation of what happened and why. It is the very least they can do and will reduce the number of negligence claims made against them.