The Maternity Crisis & Me
What is going on in maternity care in the UK, and how the hell do I navigate this shitshow?
Did you know that the CQC (that’s like Ofsted for healthcare) recently rated TWO THIRDS of all UK maternity units as unsafe? In fact ‘dangerously substandard’ was the exact term. Two thirds. That’s 67%. The number of units rated ‘outstanding’? Zero.
(Source: https://lordslibrary.parliament.uk/performance-of-maternity-services-in-england/)
This piece is not here to scare the shit out of you, don’t get me wrong, consider it more a friendly word in your ear - if you’re expecting a baby there are some SERIOUS QUESTIONS you ought to be asking, and they’re not the ones you might be thinking….
OK, so you’re pregnant, you’re excited (and a bit terrified), and you’re wondering what all the noise about maternity unit failings means for you. Or maybe you’ve been here before, you placed your trust in the maternity system and it didn’t turn out the way you had expected. Now you’re pregnant again and wondering how to navigate your way through.
First off, welcome. My name is Debra and I’m a doula - a professional pregnancy & birth companion, advocate, and general all-round support superhero. I do this work because I have been that Mum, in fact I’ve been both those Mums - the anxious first timer and the wary second-timer. I know how valuable true, honest, unconditional support is when you’re on this pathway and I’m here to bring it.
WHAT DOES BIRTH NEED TO THRIVE?
Before we can look at the ways the maternity system doesn’t serve us, we first need an understanding of the conditions under which physiological birth (that’s spontaneous, unassisted birth) works. Two things are true about birthing physiologically;
It brings countless health benefits for both mother and baby, in the short, medium and long term.
The majority of mothers want to be facilitated to give birth without intervention where possible.
Our bodies know how to give birth, given the right circumstances.
Humans have been doing it for hundreds of thousands of years. It’s no accident that we are still here after all this time, if birth was as risky as we are all led to believe humans would have died out a long time ago!
I do feel the need to add, however, that there are some circumstances where pregnancy and birth may need some assistance, and thank goodness we have professionals able to give this assistance. This is not a manifesto that all birth is safe and all obstetric care is unnecessary. And of course there are also circumstances where a mother might choose to have an assisted or surgical birth. That is her right, just as it is another mother’s right to decline intervention.
But it remains true that the vast majority of births will begin, and proceed, spontaneously if they are allowed to do so.
Let’s take a look at the conditions needed for birth to thrive…
The disparities between what birth needs to thrive and what standard maternity care offers are stark. They are in fact polar opposites.
STANDARD MATERNITY CARE IS THE ANTITHESIS OF BIRTH
What do you imagine when you close your eyes and think of childbirth?
bright overhead lights
the groans and moans of labouring mothers
busy, stressed midwives rushing around
lying on a bed, feet in the air
wires everywhere, monitors beeping
charts, notes, tickboxes
being told what to do and when to do it
feeling like a patient
Have you ever owned a cat? Or known someone whose cat has had kittens? Think about what the mother cat does in the run up to her birth - she finds a cosy little nook, somewhere private, quiet, safe, where she won’t be disturbed and can birth her kittens in peace. If she gets disturbed she won’t birth those kittens - her body will shut down until she can find a new spot, away from prying eyes. This is because she knows instinctively what her body needs, the conditions under which the wonderful cocktail of birthy hormones can flow unimpeded, and they are exactly the same conditions that humans need for birth to progress.
OXYTOCIN, MELATONIN, ENDORPHINS…
These are just three of the ingredients for labour, and they all need the same things - peace & quiet, low light, privacy, familiarity, to be unobserved and uninterrupted.
Oxytocin is The Queen of birth hormones. If she ain’t there, the party isn’t happening.
😶 Imagine Glastonbury without the music.
😶 The Olympics without the athletes.
😶 A roast dinner without the spuds.
Labour just won’t start without oxytocin, so why are we creating the exact set of circumstances needed to scare her off?! (And when I say we, I mean Industrialised Maternity Care. Not me personally, I definitely don’t do these things!)
If it helps, consider that oxytocin is also a key ingredient when we need to have a poo, and when we have sex…
Could you take a dump here??
Photo of glass walled public toilets.
Could you make love here??
Photo of a luxury bed showroom, multiple beds lined up on public display.
Why not?
… because you’re on display and probably going to get interrupted!
[FYI - a great hack to remember when planning your birth space… ask yourself “could I make love here?” and “could I poop here?” If the answer to either is No, you have some troubleshooting to do!]
💩 Do we demand people do all their pooping in public, monitor their progress, and then bombard them with drugs and instruments when things inevitably slow down?
❤️🔥 Or do we insist everyone have sex in busy dormitories, give their orgasm a deadline, and tell them they ‘failed to progress’ when the Big O doesn’t ohhhhh?
🐮 So why the fuck are we lining mothers up like cattle on a ranch and throwing all these obstacles their way?
And here’s the rub, the biggest stitch-up of all -
blaming the mothers themselves when birth didn’t proceed as it should have.
How many times have you heard someone describe their birth say something along the lines of “Thank goodness I was in the hospital, they saved my baby’s life”.
My friends, we have all been royally fucked over.
IS IT ANY WONDER WE ARE SEEING BIRTH OUTCOMES LIKE THIS…?
⚠️ 40 - 50% caesarean birth rates
⚠️ >30% induction rates
⚠️ >12% forceps/ventouse births
⚠️ 80 - 90% of births on consultant-led units
⚠️ >60% epidural rates
⚠️ <1% homebirth rates
And as a consequence, we’re seeing record levels of birth trauma and postnatal mental health struggles, rising rates of NICU admissions, and growing levels of maternal mortality. And absolutely no reduction in stillbirth rates or neonatal mortality.
(Source: https://www.npeu.ox.ac.uk/mbrrace-uk/reports)
HOW DID WE GET HERE, AND WHO IS TO BLAME?
There’s no simple answer to that question, but a few key things have contributed to maternity care becoming the conveyor belt system it is:
Decades of under-investment in healthcare, particularly maternity care, have left it existing on the bare bones of what it really needs.
Widespread staff shortages mean midwives are spread so thin they don’t have the capacity to offer the standards of care families deserve.
A move away from a Continuity of Care model, whereby mothers would have an allocated midwife who would see them throughout their pregnancy and birth.
Massive cuts to homebirth services and midwife led units since the pandemic, most of which have not been reinstated, meaning the huge majority of mothers are birthing on consultant-led units.
The chronic burnout and high turnover of staff - for every 30 midwives trained, 29 will leave the profession!
An emphasis on standardised care as opposed to individualised care, with little scope for staff to offer care 'outside of guidelines’.
A fundamental policy change for midwives since the pandemic, whereby their primary obligation is now to their employer rather than to the family in their care.
A culture of fear amongst staff, hierarchical structures and lack of protection for whistleblowers.
The general risk-averse nature of maternity care, and while this may sound positive, it has led to intervention-heavy practices, often creating more risk than they are reducing.
Hospital policies based on resourcing and finances, rather than best practice; it is now more financially viable to perform a planned caesarean with a short stay in hospital than to await spontaneous labour, which could last many days and require allocation of more staff and resources.
Financial rewards for hospitals for performing surgeries and instrumental births.
NATIONAL SCANDALS
With ⅔ of maternity units graded unsafe, there are bound to be repercussions.
You might be aware of the numerous recent investigations into maternity care across the UK; the Morecambe Bay scandal, the Ockenden Enquiry at Shrewsbury & Telford, the Kirkup Enquiry at East Kent Hospitals, the ongoing investigation into Nottingham University Hospitals…
…all have found massive failings in care leading to the death of and serious harm to mothers and babies. And all have common themes;
Not listening to mothers
Staff shortages
Systemic racism
Culture of fear & coercion
If you are aware of these enquiries, you might also have read how the reports tried to blame a culture of ‘pushing natural birth at all costs’, when opting for caesarean birth may have saved some babies’ lives. But let’s get one thing straight - this is another big fat lie we’ve all been told. The births in question may have been vaginal, but they were anything but ‘natural’, having been induced, augmented and generally meddled with until they reached a critical point, and then caesarean birth withheld.
It was this spin of the Ockenden Report of Shrewsbury & Telford NHS Trust that led to the scrapping of the cap on caesarean numbers nationally, which is why we’ve seen such an explosion of caesarean births in the last couple of years.
You might think this is a positive move, removing barriers and giving more mothers the option of caesarean birth, but what we’ve ended up with is a situation where induction of labour and augmentation is pushed on so many more mothers, since caesarean birth as a ‘get out of jail’ card is now so much more easily accessible when things go awry.
And the more caesareans a unit performs, the more funding it gets allocated in the next financial period. In addition, being able to schedule inductions allows a hospital to plan their rotas much more accurately, a valuable tool when midwife shortages of between 10% - 35% are reported.
(Source: Midwife quit over 'unsafe care' and staffing - BBC News.)
THIS IS ALL REALLY SCARY! WHAT CAN I DO ABOUT IT!?
Like I said before, it’s not my intention to frighten you, but if all this is giving you pause for thought then maybe it's time to ask yourself some serious questions…
What is important to me?
How safe is my maternity unit?
Is the care I’m being offered the best choice for me and my baby?
What do I need to do to ensure our needs are met?
Where can I find unbiased information?
What additional support do I need?
The answers to these questions are going to be different for everyone. And THAT is the point I’m making - standardised care is not the way!
So what can you do?
So much, but here’s a few suggestions to get you started…
GET INFORMED - read, listen to podcasts, join online communities, soak up as much info as you can about birth in all its wondrous variety.
GET PREPARED - take a birth preparation course, whether that’s hypnobirthing or something different, but FFS make sure it’s independent of your care provider!!
DO YOUR RESEARCH - what is going on at your local maternity unit? What kind of outcomes do they have? How likely are you to get the birth you desire under their care?
OPEN YOUR EYES - to the bullshit we’re sold about birth as a risky predicament needing medical management.
BE BRAVE - if you want to protect yourself and your baby from potential harm, you’re going to have to take radical responsibility for your own experience. As the incredible Brené Brown says, we have a choice between short term discomfort, or long term regret.
GET SUPPORT - scrimp, save, reprioritise, ask for donations instead of baby gifts, but try and find a way to afford some additional support. Whether that’s a doula, birthkeeper or independent midwife, someone who works for you and will centre you is an investment you will never regret.
If you want to tackle your barriers and create a personalised plan for a wonderfully transformative autonomous birth, schedule a free Discovery Call today!
Take care of yourselves Mamas.
Big love,
Debra xx
Take a look at my next level Doula Support Packages here:
And if you’d like to book a free Discovery Call to chat through how I might be able to help you, click here:
