The Government will need to go much further to address all the inequalities impacting maternity care - Sally Simpson
Birth Trauma Awareness Week is run by the Birth Trauma Association and it has three stated aims; to draw attention to the subject of traumatic birth and its impact, to share useful information about birth trauma including how to get help, and to encourage people to tell their stories and reduce the taboo on traumatic birth. This year’s Birth Trauma Awareness Week, which took place last week, looked to shine a light on inequalities in maternal care.
Recent research and inquiries have highlighted the poor levels of maternity care across the country, finding factors such as ethnicity, socio-economic status, age, language barriers, neurodiversity and disability are linked to poorer outcomes, including contributing to birth injuries and higher mortality rates in the UK. As a lawyer working on medical negligence cases involving birth injuries and trauma, I sadly see the part that inequalities play in my cases.
Poor maternity care across the country, including Leeds Teaching Hospitals recently, is simply unacceptable. In addition, your ethnicity, socio-economic background, disability, or age shouldn’t matter – the standard of maternity care should be consistent and fair.
The research on inequalities is stark. According to MBRRACE’s most recent report, Black women are three times as likely as White women to die during pregnancy, childbirth or the postnatal period, while Asian women are twice as likely to die as White women. Women living in the most deprived areas of the UK are more than twice as high as that of women living in the least deprived areas. The report by the All Party Parliamentary Group (APPG) on Birth Trauma, titled “Listen To Mums, End the Postcode Lottery for Perinatal Care”, highlighted that many women cannot afford to travel to the hospital or their GP practice and therefore miss important antenatal appointments. In addition, NHS prenatal support is patchy and recent reports show funding cuts are being planned in areas like prenatal mental health, at a time when demand has never been higher.
The Birth Trauma Inquiry Report also highlighted that some of their submissions from young mothers “suggested that they were treated less sympathetically because of their age.” One young mother we represented felt her concerns weren’t taken seriously by midwives because of her age when she gave birth. Because of this, she was left unmonitored during her labour, which led to her baby being injured.
Moreover, language barriers and lack of interpreters working in the NHS is contributing to fatalities and serious injuries in maternity care.
An investigation by the BBC found that interpreting issues, “were a contributing factor in at least 80 babies dying or suffering serious brain injuries in England between 2018 and 2022.”
I have also seen neurodivergent clients struggle to receive the information they need in an accessible format throughout pregnancy and labour. There’s also an inconsistent approach to this issue across NHS Trusts.
One of our neurodivergent clients had two completely different experiences when she had one of her children with a Trust offering a much more tailored delivery of vital information to accommodate neurodiversity. In contrast, when she had her other child at another Trust that didn’t do this, our client struggled to give informed consent.
To be able to give informed consent before receiving any type of medical treatment, test or examination, a person must be able to understand the treatment they are receiving, be informed of what it involves, and their consent must be given voluntarily. This is not possible if a person cannot understand the relevant information to base their decision on.
Furthermore, a recent report by The London School of Hygiene & Tropical Medicine found “44 per cent higher odds of stillbirth or neonatal mortality for infants born to disabled mothers” in the UK.
Even at a more basic level, I am aware of our clients having to deal with a general lack of accessible facilities, such as disabled parking and toilets, and facing some medical staff having preconceived ideas about pregnancy and disability.
All of this makes for sobering reading. The APPG on Birth Trauma Inquiry in May 2024 recognised these inequalities when they published their recommendations to address the poor outcomes in maternity care.
Frustratingly, little progress has been made on these recommendations but I hope they will be factored into the recently announced National Maternity Inquiry and its national set of actions.
Whilst it is encouraging to me that the National Maternity Inquiry has already committed to creating an anti-discrimination programme to tackle inequalities in care for Black and Asian women and those from deprived communities, the government will need to go much further to address all the inequalities impacting maternity care across the UK.
Sally Simpson is a partner in the Brain Injury Team at Bolt Burdon Kemp.