Why is maternity care so crap in the UK?

[Oohooh]

I’ll start by saying I’m sure some of you have had good experiences, but virtually everyone I know seems to feel their care was substandard, and not just due to pressure on the system.

Particularly if you are induced or have some kind of risk factor it feels like women aren’t listened to or believed if they’re in pain, are denied pain relief, are left to labour for hours without any kind of proactive support or help to avoid instrumental deliveries. Then ignored on the postnatal ward as they struggle to care for the baby.

My first experience was okay-ish although the pain relief took hours to come and they just shrugged their shoulder when it didn’t work rather than offer me anything else. Second time was utterly dire - induced, left in a tiny cubicle behind a curtain until I was 10cm because ‘you’d be making more of a fuss if you were in labour’, midwife lied in my notes (for which I received an apology and she was allowed to carry on), denied pain relief, crucial medications not administered resulting in a poorly baby - just awful. The whole thing felt completely out of control.

And obviously some maternity units are so bad they’re subject to public inquiry.

What’s going on?

The NHS is effectively free for the majority of its users because they don't earn, or have never earned, anywhere near enough to pay net taxes into the system.

Current state of maternity provision on the NHS is partly due to the horrendous underfunding of the NHS under the Conservatives. However, there have been systemic issues with maternity services since the NHS began that pretty much all boil down to the service not listening to patients.

Of recent maternity scandals, Morcambe Bay, Shrewsbury and Telford, and East Kent all started under the Labour government when the NHS had had significant investment.

I do agree with a previous poster that there has been an ideological push towards "natural" childbirth that has not been in women's best interests, though I don't think the pressure has been just from midwives.

your right, but they dont know the difference, to them they are providing a brilliant free service and everyone should do as their told

The NHS is crap. Therefore women’s experiences are crap. I won’t bore with my horrific birth experiences. And thereafter negligence in thr local children’s hospital

needless to say, I do everything I can to avoid needing any medical help.

“See my pp, my post section didn't even get paracetamol last week.”

Language like that dehumanises women.

@UtredSonOfUtred I have never thought about it but this happened to me with both my labours. “She can’t be” was the exactly what the midwife told my dh at 4am when I asked him to fetch her. She told dh that I needed to keep walking around … if I had, my baby would have been born in a corridor as I was 10cm. I had to persuade my dh to go back and insist that she came, right now. The midwife’s decision was based on the “fact” that I was too chatty and polite when she had seen me an hour earlier.

I think the midwives have been trained that “women don’t like being monitored; women labour more effectively if you let ‘nature take its course’” which is ironic because I was being induced (not my choice; that was hospital policy due to my age even though the consultant said it was unnecessary in my case). And nature does sometimes function perfectly, which feels miraculous and spiritual. But sometimes it leads to ugly outcomes and levels of pain no one needs to endure.

I found the same thing in the palliative care team once or twice - this almost religious belief in nature taking its course, which in fact cause immense suffering for my relatives rather than the medical professionals believing that in even in my heightened emotional state I was able to observe the patient’s condition which I had watched for months during their illness - and I knew what their pain and suffering looked like.

Not being believed by doctors is as prevalent as not being believed by midwives.

I had one of these in Belgium also with zero pain relief. The system is different there and you go directly to a gynaecologist. I was under him for ivf. He said he wanted to sample my womb lining and just did it there and then. No discussion regarding pain relief etc.

I do think there's a weird culture of healthcare in the UK. There's this intense adoration of "the NHS" as a system or concept, even though it seems like individual patient treatment within it is not very good.

I live in Aus (I'm from the UK) and healthcare has issues here too, in particular with increasing privatisation. But healthcare seems more respectful of patients- both in the interpersonal relationships with doctors and nurses, and how patients are treated in systems and procedures.

I have had three births and an ectopic pregnancy. Care for all of them was good. For one I lived in the outback and remote care was still outstanding. It was of course a mixed bag- I got on better with some than others, felt listened to by some and less so than others- but the overall experience was excellent. But overall I felt like an individual, like I wasn't been forced onto a (literal!) production line and my particular needs and wishes were considered.

Reading the previous poster who is a midwife, it seems like staffing is a major problem. And I actually agree with her that the 90 of birth stories beginning with "I went to hospital but it was too early so they sent me home and then eventually when I came back I was in established labour" just aren't told so the 10% seem like the majority. But I also agree with other posters- there's almost a paternalism in the NHS that those working within it know better than those being treated within it, resulting in a failure to listen to individual needs.

Yanbu about the not believing you’re in pain. I was also found to be 10cm after the woman in the next bed pressed the buzzer for me, despite them repeatedly telling me ‘you’d be a lot more uncomfortable than this if you were close’

Why do they think that unless you’re mooing like a cow, you can’t be in labour/pain.

My experience was dreadful at literally every stage. I went into labour at night so they were desperate for me not to come in, kept sending me away both in person an then over the phone despite regular contractions, throwing up etc - ended up fully dilated trying not to push for almost an hour in the car there. Put on back with feet in stirrups to push for five hours before being taken for a forceps delivery. They caused excessive trauma during the episiotomy (my scar is several cms longer than it should be), causing a hemorrhage, literally spraying my husband with blood, and leaving me with prolapses of both bladder and bowel. And then we got left for 4 days on a postnatal ward for "feeding support" - didn't see a qualified midwife for 6 hours, who lied and said formula was medically urgent. Only one more midwife came to help with feeding after that on one occasion over the course of the next three days- we were just left ringing a buzzer endlessly.

I made a complaint so I have some understanding of what the problems are.

• Massive understaffing - the hospital was on red staffing
• 30% of their staff are "very new to their careers" - I actually remember someone asking the student midwife to do something, I think with the cannula, and she said she wasn't comfortable doing it. I would say the average age of the midwives I interacted with during the actual delivery was about 23/24.

But also
I think a lot of midwives are a bit thick? I understand newer midwives don't receive the same training that older ones did, but noone seemed to know what to do when my baby didn't latch, for example. I'm pretty sure I know more about breastfeeding now than they do. Similarly, when I made my complaint, the senior midwife seemed to think prolapse would heal itself, and didn't have any idea what happened at pelvic physio. I'm a teacher, so a bit of a jack of all trades, but if you gave a crap about your job wouldn't you at some point have googled these things?

I also think there's a real internalised misogyny/ victim blaming attitude towards patients. I've been told multiple times during the complaint process that I should have said no - should have refused to leave hospital when they sent me away at assessment, should have got up when they put me on my back etc etc. Basically that I shouldn't have trusted them, the medical staff.

Yes birth plans. What utter garbage and a terrible ruse to blinker and subdue women these are.
They are not taken notice of, so I didn’t bother after the first.
So much poor care of women in hospitals.
Odd pockets of good care, but too little.
And now it’s worse, no doctor’s appointments to be had, see a pharmacist.

I'm a midwife who trained and worked in the UK and now work in Canada so I have experience of more than one system.

I think there is a culture on some maternity wards in the UK of not listening to women, just getting on with it, apathy etc. I experienced that myself. I don't see that here in Canada, by and large I think care is a bit more compassionate and individualized. It's a difference in the culture of maternity care and something that needs to be addressed, but it is also not universal by any means. One issue is that most women in the UK don't have a named midwife or team, and that leads to fragmented and less invested care.

Pay and conditions were not good in the UK, and they're worse now. The staff ratios on the postnatal ward where I worked were awful; you simply can't give good care when you are run off your feet. There is also a culture of forms and box ticking, none of which seems to improve care, but which takes up an inordinate amount of time and detracts from care. I am SO much better paid in Canada and my work conditions are superior and less "box ticky".

I think the blame on a culture of "normal birth" is mostly bullshit. It might have held some weight at one time, but not now. Rates of induction, intervention and CS are sky high (in both countries). It is far easier to get an ELCS in a low risk pregnancy than it is to fight for a normal, home or birth centre birth in a pregnancy with any risk factors at all. I also don't think I knew many midwives in the UK who were "natural birth fanatics"; yes most wanted to support women in physiological birth, but not to the detriment of her and her baby's wellbeing. The fact is that most first time mums in the UK have an epidural.

I think women in the UK don't appreciate or realize some of the amazing aspects of care:
-an app with your maternity notes!
-Down syndrome screening results on the same day you did the test!
-a sonographer who actually explains to you what they are doing and gives you results! (They aren't allowed to tell you anything here, you have to wait to see the midwife or doctor)
-home visits! (Not universal in Canada but we do them where I work)
-a birth pool in virtually every hospital!
-a dedicated obstetric anesthetist! (There is one anesthetist on for my whole rural hospital, which can cause delays)
-a tongue tie service! (Even if you have to wait)

I know these aren't universal and it's a post of lottery, but I was blown away by some of the care aspects that my sister recently experienced at St Thomas in London).

To my mind, the things that need to be fixed in UK maternity are a kindness/compassion shift; much better pay and conditions and staffing (which would lead to more compassion); and ideally slightly smaller teams caring for women so some continuity is maintained.

I suspect it varies trust to trust. I've had 5 births and all were different but in terms of staffing I can't complain. Someone has already mentioned the UKs preference for a natural birth. This I think is 100% true and the reason they push back on intervention based methods. Other countries believe the opposite is better.

I don't think it's a funding issue I think its a belief difference. So many trusts have introduced midwife led birthing units, all of which are centred on natural birth.

I think a lot of midwives are a bit thick? I understand newer midwives don't receive the same training that older ones did, but noone seemed to know what to do when my baby didn't latch, for example. I'm pretty sure I know more about breastfeeding now than they do. Similarly, when I made my complaint, the senior midwife seemed to think prolapse would heal itself, and didn't have any idea what happened at pelvic physio. I'm a teacher, so a bit of a jack of all trades, but if you gave a crap about your job wouldn't you at some point have googled these things?

I'll confess that when I was a midwife in the UK, I wouldn't have had a clue about prolapse and pelvic floor physio. It's simply not part of the remit of someone who is working in the hospital in the immediate postpartum. I doubt I got any training on it. It's only here in Canada, where I look after mums until 6 weeks pp, that I had to start learning about this stuff. Similarly, until I breastfeed my own baby and had every problem going, I didn't know much about BF but didn't realise how little I didn't know! I guarantee that most nurses/midwives in other countries don't have a clue either. The advice I see here is mainly "use formula"; it's shocking.

I insisted upon ELCS for first (& de facto was offered one for no2)

While both were still fucking horror shows... (my dh thinks i actually have pstd from the 2nd and wants me to see someone)
I feel i did the best i could by myself by circumventing most of the opportunities pregnancy gives the nhs to ignore / neglect /fail women.

When i went into spontaneous labour in my first pregnancy the 3 hours of "maternal care" i received before managing to get my elective reinforced id made the right choice.
"Care" consisted of a bloke (no idea who or what he was. he was in triage but never introduced himself) insisting i wasnt in labour, if i was it would be slow and repeatedly demanding he physically examine me before he could do anything else to help.
🤨🙄😵‍💫

In contrast...The surgical team were gold standard and exemplary both times.

How so?

That's really interesting that you mention safeguarding as it's not an issue I've seen brought up before but wonder if it could be making a big difference. Dealing with safeguarding issues in schools is increasingly taking up substantial amounts of time every week, far more than it did before COVID. No one ever seems to consider how much time it takes out of your day and the knock on effect this has on other tasks. If it is the same in midwifery, I can imagine it's really detrimental to the care of other women on the ward.

I never had the experience of "nasty" midwives or any issues getting pain relief.

I've got nothing against targetting natural labour but its often at odds what the doctors want in terms of monitoring. They wouldn't let me get off the bed to get in a sensible position to push (squatting etc) because they wanted the various monitors in place, and as a result i just couldn't get DC1 out and had to have forceps. In theatre the dr immediately said he was almost out. I swear i could have push him out in a better position, just being flat on my back was never going to work!

Also, they seem to always assume you won't progress fast, i got sent away because i wasn't far enough gone but i told them my sisters had warned me... lo and behold when i went back shortly after i was ready to roll (too late for epidural if I'd wanted one). I think its often driven by capacity.

I'm so sick of hearing this shit. I'm a little sensitive this morning as my brothers results from hospital took 5 weeks to come back (supposed to be a week) and he has cancer. So no mens health care isn't better.
I was lucky with my first two births, emergency c section and planned c section, but they were 18 and 16 years ago.
My third post care was terrible, rubbish doctors who basically lied to me (midwives were lovely) and when we got home I kept explaining DS wasn't drinking enough but was told to keep going and he wound up back in hospital and I almost died from blood clots. Was it a crap experience? Of course. It was 2020 though so probably the worst year to give birth. So I'm not sure I can blame that on maternity care..

I am a labour ward midwife with 4 years of experience. I disagree with your assertion that we are "aromatherapists with pretensions ". For a start, my starting salary was more than a junior doctor's (this is not to say junior doctors get paid a lot of money). So from the start I have carried a lot of responsibilities. Every country on Earth with strong midwifery presence have lower CS rates and better perinatal outcomes compared to the obstetricians' led maternity healthcare systems. I also disagree with your assertion that induced labour is cheaper than an elective CS. Induction typically takes 2-3 days while an ELCS takes 40 minutes (plus 20-30 minutes to establish analgesia). Going back to the OP post... we don't have enough midwives to provide high quality-care. Listening to women's views and preferences takes time. However on the induction bay a midwife is responsible for 4-6 inductions simultaneously. So there might be something urgent going on of which the midwife is keenly aware. The labour ward is often short-staffed which means the woman's pain is often delayed as the priority is on providing safe care. For example we can't give a woman an epidural unless we have a midwife to stay with her in the room. If we give a woman morphine she might end up delivering on the antenatal ward which is not ideal. The reason people don't generally complain about IT engineers or lawyers is because there is no shortage of them. However their pay is determined by the private enterprise. Our pay is determined by the Government which thinks we get paid plenty. Until our pay improves the midwives will continue to leave and the maternity care will continue to deteriorate. My sister-in-law is a childminder. She makes more money than me and never once did she had to work for 12.5 hours without a tea break (never mind the lunch break).

I really don’t buy the ongoing argument that stressing ‘natural birth’ is what got us here. Most bad stories you hear are due to interventions (the induction rate is ridiculous, and inductions obviously come with risks). The terrible stories you hear in the news where babies and mothers have died are almost always due to absolute medical neglect. Insufficient staffing levels and overworked, stressed midwives are the real issue.

As an ex-practicing midwife the OP hurts on so many levels. The main one being that it’s true, and it’s the reason I left.

It is impossible to give good care within a system that does not recognise the needs of women and families. All women need one to one, personalised care, not just those who have reached an arbitrary 4cm. But instead an antenatal ward might be left with one midwife and an HCA if you’re lucky overnight.

Then you have policies that are designed to ‘save babies lives’. Obviously this sounds wonderful. And it sounds callous to suggest that this is causing harm. Losing a baby is a horrific event that no family should ever have to experience. However, rolling out policies such as early inductions which cause traumatic labours (for women and their babies), instrumental deliveries, and a c section rate which is hovering somewhere around 50% is not in the best interests of our clients. For the sake of saving one baby in every few thousand, we are traumatising hundreds of those women, lowering our breastfeeding rates and causing goodness knows how many birth injuries. Weighing up the cost is a job I’m glad I don’t have to do. But what I do know is that presently mental health services, gynaecology services, and GPs are not equipped to pick up the pieces.

On top of this, there is the mounting pressures of paperwork and auditing. When I discharged a woman and her baby from community care, I would have 5 or 6 different pieces of paperwork to complete. Each woman got a 15 minute appointment. In the appointment I saw supposedly going to be able to change a wound dressing (if needed), talk about mental health, watch a full breastfeed, weigh the baby, and give information and advice. I didn’t get admin time after these clinics. Competing departments (the infant feeding team, risk management etc.) would all be breathing down our necks about X audit being completed and we would be pulled up for not doing XYZ. It’s the care that ended up slipping.

Nobody goes into midwifery, nursing, or medicine set on giving bad care. But it does happen.

this. And I would add that if you want to comparison to European countries who also have socialised medicine, well there are no midwives, not to the extent that the UK uses midwives for birth. I currently live in a European country and the standard is for women to have an OB/GYN, and they will be present during the birth. I had my baby on the NHS and like you say it was okay. I was given pain relief but it took a long time to come and there were other aspects of my birth that I didn’t care for. I was lucky because one nurse took a strong interest in me. She was convinced I wasn’t well after giving birth and she was right. I was severely anaemic. It took me so long to recover. I also had so much trouble breastfeeding and all of these midwives kept saying you must do it. You must do it. Then an older midwife stepped in and said just give your daughter a bottle she’s losing too much weight. there seems to be in my opinion a complete lack of practical and common sense among some midwives. And they do have too much power.

My experience with my circle of friends was a real split - the ones who educated themselves on birth and their choices during labour and had informed husbands ready to advocate for them had great experiences, smooth births and felt listened to. The ones who went in blind or were induced were all terrified, vulnerable and ignored. So I think a large part of the poor maternal care is this lack of understanding and an understaffed midwifery unit not having time or the inclination to teach the full picture during a busy shift.

I had a homebirth as I really didn’t like the idea of being told I couldn’t have a water birth or that my husband must leave after - and my midwives were amazing stayed out of the way and let us get on with it, but I don’t think you can sign up to be a homebirth midwife without intending to listen to women and play it more on their terms.

Jesus.