Listen to Mums: Ending the Postcode Lottery on Perinatal Care (A report by The All-Party Parliamentary Group on Birth Trauma, 13 May 2024)

Summary

On 9 January 2024, the All-Party Parliamentary Group (APPG) on Birth Trauma established the first national inquiry in the UK Parliament to investigate the reasons for birth trauma and to develop policy recommendations to reduce the rate of birth trauma. Seven oral evidence sessions took place on consecutive Mondays between 5 February and 18 March 2024 in the House of Commons. The Inquiry was also informed by written submissions which were received following a public call for evidence.

The inquiry received more than 1,300 submissions from people who had experienced traumatic birth, as well as nearly 100 submissions from maternity professionals. It also held seven evidence sessions, in which it heard testimony from both parents and experts, including maternity professionals and academics.

Content

For any parent, having a child will be one of the most momentous and memorable occasions of their life. When something unexpected happens during a pregnancy or birth it can lead to lifelong physical and psychological consequences that often remain unknown and unspoken about.

This Birth Trauma Inquiry is, in its simplest form, an attempt to break this taboo and share the stories and experiences of mothers and fathers publicly and start a public discussion on the realities of giving birth and how we can practically improve maternity services.

The key conclusion has been on the need to introduce a base standard in maternity services across the United Kingdom. Currently there are several strategy documents relating to maternity but no single overarching document. We believe that maternity strategy should be brought into a single, living document, hosted on the UK government website and continuously brought up-to-date.

To this end, the All-Party Parliamentary Group on Birth Trauma calls on the UK Government to publish a National Maternity Improvement Strategy, led by a new Maternity Commissioner who will report to the Prime Minister, which will outline ways to:

1. Recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services and provide mandatory training on trauma-informed care.

2. Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.

3. Offer a separate 6-week check post-delivery with a GP for all mothers which includes separate questions for the mother’s physical and mental health to the baby.

4. Roll out and implement, underpinned by sufficient training, the OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce risk of injuries in childbirth.

5. Oversee the national rollout of standardised post birth services, such as Birth Reflections, to give all mothers a safe space to speak about their experiences in childbirth.

6. Ensure better education for women on birth choices. All NHS Trusts should offer antenatal classes. Risks should be discussed during both antenatal classes and at the 34-week antenatal check with a midwife to ensure informed consent.

7. Respect mothers' choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.

8. Provide support for fathers and ensure nominated birth partner is continuously informed and updated during labour and post-delivery.

9. Provide better continuity of care and digitise mother’s health records to improve communication between primary and secondary health care pathways. This should include the integration of different IT systems to ensure notes are always shared.

10. Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.

11. Commit to tackling inequalities in maternity care among ethnic minorities, particularly Black and Asian women. To address this NHS England should provide funding to each NHS Trust to maintain a pool of appropriately trained interpreters with expertise in maternity and to train NHS staff to work with interpreters.

12. NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.