Birth Trauma Inquiry: Where are we one year on and why there's still a long path to ensure all women receive safe care during childbirth
On 13 May, 2024, the first Parliamentary Inquiry into birth trauma was published. The publication followed the gathering of 1,300 written submissions from parents and professionals which revealed often harrowing accounts of traumatic birth and systemic failures in maternity care across the UK.
Research shows that 4-5% of women develop post-natal post-traumatic stress disorder after giving birth, equivalent to 30,000 women every year - and as many as one in three found some aspects of their birth experience traumatic.
The inquiry was prompted by Theo Clarke’s own traumatic birth experience. The former MP bravely and publicly spoke in the House of Commons describing what she went through as the “most terrifying experience of her life”. Subsequently, the All Party Parliamentary Group (APPG) on birth trauma, co-chaired by Theo and Labour MP Rosie Duffield, was formed.
Ending the postcode lottery on perinatal care
The inquiry report entitled Listen to Mums: Ending the Postcode Lottery on Perinatal Care, written by Kim Thomas secretariat of the APPG and CEO of the Birth Trauma Association, was also based on testimony during seven evidence sessions examining mental health services, to the wider impact of birth trauma, partners' perspectives, birth trauma and marginalised groups.
I was privileged to represent many women I've met through my work with the MASIC Foundation - the only charity to support women with severe perineal injuries - and provided oral evidence on birth injuries describing the devastating long-term impact that OASI (obstetric anal sphincter injuries) can have on both the physical and psychological health of thousands of women.
The report revealed that policy on maternity care was fragmented and several common themes emerged from the submissions; from a failure to listen to women, lack of informed consent, poor communication, lack of pain relief, lack of compassion and poor postnatal care amongst other widespread failings.
Inquiry recommendations
The Inquiry wanted to put women at the centre of care and called on the Government to publish a single National Maternity Improvement Strategy, led by a new Maternity Commissioner to implement the following recommendations:
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 six-week check post-delivery with a GP for all mums 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 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. The National Institute for Health and Care Research to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.
A landmark moment after my own birth trauma
It felt like a landmark moment. Finally, years after my own birth trauma in 2008 where I sustained severe obstetric injuries during the birth of my daughter Maya which left me with permanent life altering symptoms, and building on previous high-profile investigations such as the Ockenden Review and the Kirkup Report, this inquiry looked to overhaul maternity services and to develop impactful policy recommendations to reduce the rate of birth trauma.
Advocating for change
A key component of my evidence was advocating for standardised NHS ante-natal classes so I was encouraged to see this incorporated as one of the headline recommendations.
Every woman deserves evidence based information on labour, pain management and post-natal recovery delivered in a culturally competent manner. Knowing what to expect during birth and the choices available can reduce the trauma that many women experience and facilitate true informed consent.
Speaking at the Inquiry’s launch in the Houses of Parliament on 13 May, 2024, the then Health and Social Care Secretary Victoria Atkins acknowledged the need for systemic improvements in maternity care across England aiming to make it “faster, simpler and fairer” for all mothers and outlined several key initiatives.
These were :
- Support for a comprehensive national strategy to create a cross- government strategy aimed at enhancing maternal care.
- The introduction of standalone GP appointments six to eight weeks after giving birth.
- NHS England to co-produce new decision-making tools with new mums to help guide through choices on how they give birth, what interventions could happen and what pain relief they should be offered. These will be made available in a range of languages and formats to make sure that they can be tailored to different settings and to different local populations.
- Improved perinatal pelvic health services will be rolled out, including guidance to better support women who experience serious tears.
- That the National Institute for Health and Care Research will commission new research into the economic impact of birth trauma, including how this affects women returning to work.
- Health Minister, Maria Caulfield MP, to chair the next session of the Men’s Health Task and Finish Group to focus on dads mental health and trauma so that we can better understand how to support partners
The then Prime Minister Rishi Sunak also committed the previous government to implement a National Maternity Strategy in his Final Prime Ministers Questions.
Progress since the report
Several of the key recommendations from the Inquiry have seen some progress most notably;
- Implementation of the OASI Care Bundle – the Royal College of Obstetricians and Gynaecologists has endorsed the nationwide rollout of the Obstetric Anal Sphincter Care Bundle which will lead to a reduction in severe perineal tearing, a condition that can devastate women’s lives.
- The Royal College of Midwives (RCM) has advocated for the digitisation of mums' health records to improve communication between primary and secondary healthcare providers, aiming for better continuity of care.
- Expansion of regional perinatal mental health services, though access remains inconsistent across different regions
Recommendations still pending
However, a year on the incoming Government hasn't referred to the Birth Trauma Inquiry or cross – party headline recommendations in its manifesto or budget, and there has been no written response to the report recommendations.
The Health Service Journal also revealed that National Service Development Funding for maternity services has been shockingly cut from £95 million in 2024-25 to just £2million in 2025-26. Commenting, the RCM’s chief executive Gill Walton said: The current focus of the three-year plan is to have standards and structures that underpin safer, more personalised, and more equitable care, how will this now be achieved”.
Conclusion
Labour has committed to training thousands more midwives but in light of the above announcement it's clear there's still a long path ahead to ensure all women receive safe, respectful and compassionate care during childbirth, and the 1,300 women who submitted their traumatic birth stories, including myself, can have hope for the future.
Find out more about Irwin Mitchell's expertise in supporting mums following a birth trauma injury at our dedicated birth injury to mother claims section.
