Birth in Britain: Too few midwives, too many risks

Sally Pattinson had every reason to expect that the birth of her first child would be straightforward. But clinical staff had failed to detect that baby Amy, at 12lb, was unusually large. The infant died from oxygen starvation and severe brain damage shortly after her birth.

"Everything was going normally when I went into labour," said Mrs Pattinson, who came close to dying during the birth. "Then they said they didn't think the baby was coming and called for a doctor, who tried to get her out with forceps.

Related articles

• Leading article: Midwives: end the crisis
• Women's deaths soar in NHS midwives crisis
• Search the news archive for more stories

"It all went mad. I was bleeding heavily and torn quite badly. I'd lost so much blood that I had to be given a transfusion."

Doctors told Mrs Pattinson and her husband John, from Twickenham in south-west London, that Amy had little chance of survival, so they took the agonising decision to turn off her life support.

"We held her in our arms, christened her and then just turned off the machine," recalls Mrs Pattinson, who is now the mother of twin boys.

Childbirth should be a safe and positive experience for most British women, thanks to advances in medical technology and training.

But figures obtained by The Independent on Sunday reveal that Sally Pattinson is far from alone in the trauma she suffered. The lives and health of thousands of women on maternity wards are being put at risk every year, with many suffering permanent physical and mental scars.

According to a study by the National Patient Safety Agency (NPSA), which was set up to learn from medical mistakes in the NHS, 18,000 mothers have been physically injured as a direct result of being in maternity care. This figure includes 246 cases where pregnant patients died and another 1,000 where women suffered "serious harm", including from perforated bowels during surgery. This means that in some cases women have needed a temporary colostomy.

The findings are based on the NPSA's study of 60,000 maternity care blunders that occurred between November 2003 and June 2006. Even the 10,000 injuries rated as "low harm" in the NPSA report, including perforated bowels repaired during birth, would be considered traumatic by most people.

The patient safety watchdog claims that the majority of women receive "high-quality maternity care" from the NHS. But experts insist that these complications and, in many cases, avoidable deaths of women during childbirth are a growing phenomenon. They blame them on a lack of qualified medical staff, including midwives and obstetricians, and the rise in the number of cases of Caesarean sections.

Professor Jason Gardosi, a senior obstetrician, said the problems with maternity care in the UK were "endemic", that the injury and death figures were "the tip of the iceberg" and that substandard medical care was not being detected because of a lack of proper monitoring.

"Staff are doing their best within the confines they are given, but in many instances, mothers and babies only survive because they are lucky," said Professor Gardosi, director of the NHS Perinatal Institute, an academic research centre.

"The single largest problem is the lack of resources: for example, a lack of ultrasound equipment, followed by a lack of staffing, which allows mistakes to happen. You would not allow an aeroplane to fly without a full crew, but midwives have to make do without a full staff. It is little wonder that we see so many avoidable deaths."

Older mothers have fuelled the growing trend for medicalised deliveries including Caesareans. More than a decade and a half ago, Caesareans accounted for just 9 per cent of all deliveries in Britain but they now represent nearly 22 per cent of births.

The latest statistics show that the highest percentage of C-sections take place in London, where they accounted for a quarter of deliveries. This goes against advice from the World Health Organisation (WHO), which recommends that Caesarean deliveries should represent no more than 15 per cent of all births.

The increased medicalisation of birth is of great concern to many doctors, who fear that it increases the risk of complications especially at a time of NHS staff cutbacks. Dr Janet Baldwin, a childbirth expert, blames the increase in Caesarean sections on a reduction in the numbers of qualified staff and a fear of litigation. "More Caesarean sections are being done because of a fear of litigation and as a precautionary principle rather than in a genuine life and death emergency," said Dr Baldwin, clinical lead for the Caesarean section team at the NHS Institute

"We believe that about two-thirds of units in the country either have too few staff or their balance of skills is inappropriate to give the best care. More mothers may face emergency hysterectomies as a result of repeated Caesareans."

Dr Baldwin said the tens of millions spent on C-sections could be better used supporting normal births because of the higher risk of serious complications.

"The continuing rise in Caesarean sections is increasing the risk of death and injury to mothers and children," she added.

Medical professionals often point to shortages of trained staff as a reason for the growing numbers of women having bad experiences during maternity.

The picture emerging is that of a vicious circle in which a cash-starved NHS employs fewer trained staff while the number of negligence claims increases, taking even more money from the health services.

The Royal College of Midwives (RCM) said there has been an 8 per cent rise in the UK birthrate at a time when midwifery posts are vacant and many areas have a freeze on recruitment.

"Midwifery services are on a knife edge and the Government needs to take measures to address that," said Louise Silverton, the RCM's deputy general secretary.

"These underlying shortages will cost the NHS more in the long term because they will result in more litigation and large payouts. We need 10,000 more midwives to give women the care they deserve."

Blunders in maternity care are by far the biggest contributor to medical negligence payouts. Two-thirds of the top 100 claims for negligence over the past five years were the result of substandard maternity care, according to figures released last week by Patricia Hewitt, the Secretary of State for Health.

The single biggest cause was failure in responding to an abnormal heart rate in the foetus, along with failures in diagnosis and treatment.

Mothers have made £2bn worth of claims for obstetric and gynaecology mistakes since 1995, and half of these payouts have been in the past five years. The NHS Litigation Authority last year said that problems in pregnancy and childbirth accounted for at least six of their 10 biggest claims for clinical negligence.

A definitive study by the Confidential Enquiry into Maternal and Child Health (CEMACH), which looks into every case where a pregnant mother has died, shows there has been a steady increase in maternal deaths over the past 15 years.

Its experts concluded in its last report for 2005-06 that nearly half of deaths that were the direct result of complications were attributable to "major substandard care", meaning that the care "contributed significantly to the death of the mother". And 20 per cent of deaths where mothers had existing conditions that were made worse by pregnancy resulted directly from substandard care.

Many in the medical professions, as well as health campaigners, are concerned that CEMACH's next report, released at the end of the year, will show a further rise in the number of maternal deaths. Patient groups are angry at what they believe are ministers delivering maternity services on the cheap.

The pressures on maternity services risk turning what should be a magical moment in people's lives into a tragedy, said Peter Walsh, from the Action against Medical Accidents charity.

"Childbirth should be one of the happiest times of our lives, which makes it all the more tragic that we continue to see an alarming number of errors resulting in serious injuries to the child or mother," he said.

"The human cost is immeasurable, and even the financial cost to the NHS should be ample incentive to make dramatic reductions in the number of errors resulting in injury. Sadly, we continue to see familiar patterns in the kinds of errors experienced, which it should be possible to address."

The Royal College of Obstetricians and Gynaecologists has called for a massive investment in the numbers of consultants serving maternity units, so that 24-hour cover could be achieved rather than an on-call service in the evenings. The college said a second problem was the falling level of experience of senior doctors working on wards.

"The same complications that happen at 3pm happen at 3am, but the difference is in staffing levels," a spokeswoman for the college said.

"There is a shortage of consultant obstetricians, but there is no will at the moment to employ increased numbers because the service is not prepared to pay for it."

Two major inquiries have been launched into the causes of deaths in childbirth, and will be published later this year.

The first is by the King's Fund, a health charity, in response to growing concerns that women from vulnerable social groups, such as the poor with fewer health facilities, face an increased risk of death and complications during pregnancy.

The Healthcare Commission is launching a separate inquiry into maternity services. Sue Eardley, the strategy manager for childbirth and maternity care at the commission, said this was long overdue: "It does feel that there is an increase in incidents, but put alongside that, there is also a significant increase in complications."

Whatever the conclusions of these two inquiries into maternity services, it will be too late for Sally and John Pattinson.

They have now launched a legal action against the hospital trust that cared for their daughter and are campaigning for new standards in maternity care to increase detection rates of unusually large babies.

"The system is an absolute joke," said Mr Pattinson. "Amy should be here now. They might as well have shot her."

BY THE NUMBERS

£1bn+ paid out by the NHS in compensation for maternity-related claims since 2001

23% of pregnant women have Caesareans each year

15% limit on Caesareans recommended by the World Health Organisation

24% of birth units without proper medical support

722,500 births in 2005

17,000+ women harmed in maternity safety incidents since November 2003

391 women died during, or shortly after, childbirth between 2000 and 2002

48% of women have a normal birth

63% of babies are delivered by midwives each year

7,000+ maternity-related compensation claims since 1995

10,000 too few registered midwives

18,949 full-time equivalent midwives

13 women die for every 100,000 births

200% rise in elective Caesareans since 1980

50% increase in emergency Caesareans in the past decade

£1.8bn spent on maternity services in 2006

£37.7m savings if Caesarean rate fell below 20 per cent

1 in 4 chance that a pregnancy will end in miscarriage

1 in 200 chance that a baby will be stillborn

3,500 babies stillborn in the UK each year

70% of stillbirths that remain a mystery

159,642 Caesareans carried out in the UK each year

Private Medical Cover from £30 per month with Independent Compare