I Was A Midwife. Now I See What Happens When Women Aren’t Heard

I used to work as a midwife, now I’m a medical negligence solicitor specialising in maternity care – so, it’s fair to say I was heavily invested in the outcome of this week’s report from the National Maternity and Neonatal Investigation.

The 174-page report on the state of England’s maternity care reiterated what many have known for years: too many women and their babies are being failed by a system that is, as Baroness Valerie Amos described it, “not fit for the now” and “not fit for the future”.

I am of course disappointed, but not surprised, by the findings.

My experience closely reflects many of the concerns identified in the Amos report. I agree that the maternity service is in desperate need of an overhaul and that it is time to send in the cavalry. But is there a cavalry to send in?

The report highlighted numerous themes that have impacted women and their families time and time again – themes which I come across repeatedly in my work as a solicitor.

One extremely prevalent issue is that women are not being listened to, heard or believed when they flag issues.

This is one of the most common issues that maternity clients complain to me about. Many a time maternity care practitioners exhibit the “we know best” attitude, that they know more about the woman’s body than she does.

I have spoken to women whose genuine concerns were dismissed outright by midwives and/or doctors. When I have asked the women and their partners if they genuinely voiced their concerns to those caring for them, the answers common to all are, to quote, “we tried but we ended up feeling stupid as we were made to feel that we were making an unnecessary fuss”.

Invariably, such attitudes have resulted in poor maternity care experiences and equally poor outcomes, as well as serious harm to both mothers and babies.

This is another key issue within the NHS – one that I’ve witnessed with my own eyes when I was a midwife, but also from personal experience as a patient.

The problem generally starts with the woman or family’s first experience of accessing the maternity service. There is often an assumption that people of a certain colour or racial/religious group lack understanding of pregnancy, childbirth and healthcare related issues.

The result is that the information provided to them is sometimes watered down or given in a way that one might give information to a young child – what I call “Mickey Mouse information”.

With such limited information, the women and families are then disabled from asking the right questions or to advocate for themselves right from the outset.

The question is who discriminates and why? In my view, the answer lies in training. This should be a core subject in the training of midwives, nurses and doctors and in continual development courses.

The maternity service has also been designed in a way that does not ensure promised outcomes.

Women now enjoy much more choice in terms of the mode of delivery, including being able to opt to have a caesarean section without the need to show a medical indication for it.

However, my experience is that the system has not been designed to cater for that choice in practice.

I have been approached by women who had chosen an elective caesarean section and had a date scheduled for the procedure, but who attended hospital after their waters had broken and were shelved away on a ward.

They subsequently went into labour and were left to progress until they were told that their labour was too advanced to attempt a caesarean section. Some of these women ended up with birth injuries as a result. Just this week The Guardian reported that the risk of serious birth injuries for women in England is rising – and is actually at its highest level since records began.

The system still does not seem to accept that women can have a caesarean section just because they want it. The lesson to be learned here is that if you injure a mother psychologically or physically, you indirectly injure the baby.

In the majority of the cases that I have seen, mothers have struggled to bond with their babies following traumatic deliveries, both in the short and long term.

A change in attitude is needed. Once again, the answer lies in training.

This is another very common aspect of care which women and their families approach me about, particularly during labour when a woman is at her most vulnerable and should be able to rely on midwives to advocate for them.

Most women inform me that they are coerced into certain modes of delivery with their consent having been “purportedly obtained” (where consent appears to have been given, but wasn’t) and feel disempowered.

Naturally, all women want a safe delivery and a healthy baby. Indeed, as the Amos report says, there’s evidence of poor communication, including the failure to provide sufficient information to enable women to make informed choices.

Such a choice could be right or wrong, but women tell me that it is their right to exercise their choice – good or bad. The psychological impact of such failures on women is profound and long-lasting. Women usually tell me that the outcome of their pregnancy was good for the midwives and doctors, but not for them.

I don’t want to overlook the great work carried out by dedicated and caring midwives, doctors and affiliated care providers within the maternity service.

The Amos findings suggest that many of these dedicated practitioners have been let down by an archaic system and sometimes non-supportive working environment, with low morale affecting the quality of care they can give.

There is clearly a lot of work to be done to improve the system, yet one of the immediate solutions to so many of these commonly recurring problems is that healthcare professionals need to start really listening to the women they care for, and not being dismissive, even in the most urgent of situations.

Women and their babies’ lives depend on it.

Gwyneth Munjoma is a medical negligence solicitor at Tees Law, who specialises in maternity care.