The Shropshire Maternity scandal, laid out in detailed and distressing reading by Donna Ockenden’s interim report in December 2020, highlights what happens when hospital births are managed both on the frontline and at managerial level by ideological absolutism.
For a decade Shrewsbury and Telford Hospitals NHS Trust had England’s lowest caesarean rate. This was perceived, says the Ockenden report, as ‘the essence of good maternity care’. Yet what lay behind this statistical example of good maternity care were 1,800 cases of stillbirths and maternal deaths and catastrophic failures of care.
As a charity supporting women with serious perineal injuries resulting from childbirth we know that these figures would be even higher if maternal injury were taken into account.
Ockenden reports how women who begged for caesareans after many hours in labour were refused, leading to barbaric forceps deliveries. As a charity we know that beyond the distressing headlines of stillbirths and neonatal deaths, yet more women and babies will have survived this harrowing experience to be left with life-changing injuries.
Forceps deliveries involve cutting an episiotomy to make a larger exit for the baby. The force of a forceps delivery, particularly if it is carried out by a poorly trained member of staff or there has been a high dose of oxytocin given to the mother during second stage (also reported in the Ockenden report), often causes the episiotomy to tear further into a 3rd or 4th degree tear. These serious perineal injuries result in significant trauma to the mother and require emergency surgery to be repaired.
Immediately after this kind of birth a woman will be completely immobilised and unable to walk for days. She will be unable to control her bowel function and will be in a great deal of pain. There will be deep vaginal tearing and there will have been stitches to the internal and external anal sphincter to try and retain continence for that woman for the rest of her life. Some women have anal sphincter tears that are not recognised or repaired at the time and go on to require emergency surgery weeks after the birth. These women will require stomas and colostomy bags – some temporary, some that they live with for the rest of their lives.
The psychological and physical fall-out from these injuries is almost immeasurable. We know of women who have been unable to care for their children as a result of their injuries, who have had to give up their jobs, and whose marriages have fallen apart. We know of their daily suffering with pain, incontinence, pelvic organ prolapse and many invasive surgeries and procedures.
What is so hard to come to terms with when reading the Ockenden report is that many of these injuries could have been prevented with better maternity care. Every woman wants and deserves to know that her pregnancy and birth will be handled safely and with respect for her body, and this is how most women feel when they start their journey into motherhood. The shock of the reality painted by the Shropshire maternity scandal is that normal birth targets were prioritised above this basic human right for both mother and baby.
As Jeremy Hunt stated in his response to the report on the 10th December: ‘There are lessons that need to be learned immediately: no one should ever be pressurised to have a ‘normal birth’ in order to keep C-section rates low. The top priority must always be the safety of a child with any final decision taken by a mother on the basis of impartial advice.. Never has it been more important to resolve the safety issues that have bedevilled the NHS for too long.’
As a charity representing women silenced for too long we couldn’t agree more.