In the nine months leading up to the birth of my first child, pregnancy insomnia had kept me staring at the ceiling, at the curtain rail, and back again, pondering how the wriggling creature beneath my domed stomach was going to burst into the world. A showreel of agonised screams, clenched fists, soiled hospital gowns, and Alien played on repeat in my mind. Covid-19 did nothing to allay these fears, and a cosy evening in viewing “Stacey Dooley and the Lockdown Babies” was swiftly terminated when I saw a new mother with coronavirus being whisked away down a corridor.
When the day finally came, I mistook contractions for eating too much dinner. I had read so many books, said so many prayers, recounted so many affirmations and been on so many antenatal courses, I actually felt equipped, empowered and excited to give birth. Fortunately for me, what I didn’t know – when my husband was forced to leave me at the maternity unit reception in the stillness of dawn with a TENS machine stuffed clumsily up my top – was that I was not going to receive “the standard of care women should be able to expect”.
Not my words, but those of the Care Quality Commission after they downgraded the maternity unit where I gave birth to “inadequate”. As I started to undergo the single most significant event in my life, I didn’t know that the ward was unsafe and short staffed; that patient record systems were not properly linked up; that between October 2019 and December 2020, five women had died but only three were reported as serious incidents.
In the past month, the CQC has downgraded a total of four maternity units. Aside from overarching issues with staffing and safety, London’s Northwick Park Hospital has a problem with bullying (someone even shouted at a CQC inspector, mistaking them for a colleague), Colchester Hospital’s triage system is overburdened, Sheffield’s Jessop Wing isn’t properly investigating safety incidents, and at Ipswich Hospital medical staff did not always “work as a team to benefit women”.
My birth was relatively straightforward; I went to hospital, birthed a baby, returned home (we’ll skip the bit about writhing around in a birth pool, vomiting while contracting and pushing, pushing, pushing for hours). However, when I emerged from my newborn haze and other new mums started to recount their birth stories, I began to hear all sorts of harrowing accounts. The CQC’s recent flurry of negativity doesn’t surprise me at all.
It is important to note that – in amongst all the hospitals’ failures – there are still exceptional care givers. I will forever be grateful to the midwives that gently encouraged me to keep on pushing and delivered my son safely, to the doctor who calmly reassured me that I was “nearly there” when I thought I was too tired to go on, and the patient breastfeeding advisor who congratulated me when I proudly presented my first droplets of expressed milk. But even the most outstanding healthcare professional is going to be hampered by inadequate equipment, outdated systems and the demands of looking after numerous labouring women all at once.
In real terms, “understaffing” means hurried and hassled medical professionals, who just don’t have the capacity to provide a high-quality level of care. I heard tales of women waiting (usually without food or drink) for three hours while painfully contracting alone in triage, waiting six hours for a simple examination, waiting eight hours for surgery sat in their own blood and excrement, waiting so long they were fully dilated and ready to give birth and no one realised, waiting and waiting and waiting until they had to send their partner out to roam the corridors for any sort of medical assistance.
It is a fine line between fear and fortitude for a woman in labour; battle cries can easily dissolve into terrified tears. Birth is like desperately trying to stay atop a tightrope while refusing to succumb to the pit of anxiety, despair and exhaustion beneath you. It wouldn’t have taken much to push me off (still clutching my positive birthing flash cards), which is why feeling supported and noticed is paramount. There is also comfort in the fact that – should you start falling – pain relief will soften the blow. According to the NHS website, during labour women have access to gas and air, diamorphine, pethidine and epidural.
This pain relief is a human right. Birthrights, an organisation that promotes the rights of women during birth, states: “If you have requested pain relief, it should be provided unless there are good reasons for refusing to provide it, such as a clinical contraindication (ie a medical reason for not providing the treatment).” Despite this, I still heard of women not receiving adequate pain relief, not because there was a “clinical contraindication” but because there were no anaesthetists available. In one instance, I heard of a woman being informed that her current fading epidural couldn’t be topped up because the anaesthetist was otherwise occupied in surgery.
Most of the trauma suffered was entirely unnecessary. One friend is certain that if she had stuck to her guns, stayed at home and avoided medical intervention she would have had an infinitely better experience. As it so happens, she was told she was at risk of stillbirth and would need to be induced quickly, only to be left in a corridor for four hours and then asked to go home. No wonder freebirths and homebirths are on the rise. My husband has already researched the cost of private care if we were to have another child.
Something is rotten in the state of maternity care in the UK. In addition to the four recently downgraded units, The Independent reported that almost 80 maternity units across England are rated as needing to improve on safety. It would be easy to blame everything on Covid-19. Certainly, the vomit-inducing Covid-19 tests and hours of labouring in isolation made the experience of birth almost unbearable. But, the pandemic has just shone a light through cracks that already existed.
Unusually, no matter how horrific the birth story, at the end, the mum would sigh and say: “Well, I guess I am lucky my baby was healthy.” A mother’s greatest desire is to have a healthy child, but when was the last time we endured agonising pain and emotional exhaustion and still called ourselves “lucky”? When did we stop demanding great births and settle for lucky dip care where, if an anaesthetist sprains their ankle, you’ll be pushing that baby out without the relief you need?
Luck is a roll of the dice; it is squeaking through by a whisker, chancing it. Childbirth does not seem like the sort of thing that should rely on such a flimsy premise. I’d much rather have access to pain relief and a fully staffed ward of midwives than a four-leaf clover and a lucky charm, because being “unlucky” doesn’t bear thinking about. Eventually small errors lead to big ones; the midwife that doesn’t have time to fetch the anti-nausea drugs is the same one that overlooks a breached baby. Perhaps I was naive before I had my first baby, but being able to labour in a way that is safe for me and my child is a minimum requirement. I’d rather put my hope in the maternity care the NHS promises than “luck” any day.
Vogue, July 2021Categories: Uncategorised