The findings of Donna Ockenden’s report on maternity services at Nottingham University hospitals NHS trust (NUH) are horrifying. Such is the scale of suffering on the part of mothers, babies and their loved ones that it is almost beyond contemplation. Harrowing details – a room filled with the smell of infection after a woman who was told to labour at home for six days was finally granted surgery; a student doctor being allowed to perform an emergency hysterectomy on a woman, and accidentally removing her bladder; a baby’s remains being disposed of as clinical waste – haunt you long after you finish reading. And then there are all those babies, who should now be exuberant, lovely children, who died because of poor care and neglect.
The victims and survivors, who campaigned long and hard for this review, don’t have the luxury of absorbing this information at their own pace, as I had to on Wednesday. They have lived with the brutal reality of it for many long years as they have fought for justice and accountability. These “mad grieving parents” – Sarah Hawkins’ description of how they were made to feel after the death of their daughter Harriet – did not give up in their quest for answers, and though they have been vindicated, I imagine there is a bitter aftertaste. Shamefully, nearly half of the senior members of staff at NUH refused to speak to Ockenden’s review.
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So many of the findings are shocking, from the fact that this poor care was “deep-rooted” and “systemic”, to the existence of a “toxic” workplace culture and widespread staff shortages. What stood out for me – and I imagine this is true of many other women who have been pregnant or given birth – is how little women were listened to. Women consistently reported feeling dismissed, disempowered or blamed when they expressed anxiety or reported critical symptoms such as reduced foetal movements, severe pain, hypertension and postnatal deterioration. Their concerns about what was happening in their bodies were minimised, written off as maternal anxiety. They were, essentially, gaslit.
It’s an overused word, these days, gaslighting. Yet that is exactly what happened in Nottingham – and what is happening, I am sad to say, across our crumbling NHS maternity services. “If we listened to every mother’s concerns, we’d be overrun” – that’s what one clinician told Gary Andrews, the father of Wynter, who died of a lack of oxygen to the brain in “a clear and obvious case of neglect”. “I think now I can respond to that and say if you’d listened to every mother’s concerns, there would be hundreds of mothers, babies, still alive,” Andrews said on Wednesday.
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Why are women so routinely ignored? Why do so many medical staff assume that we do not know our own bodies? Especially first-time mothers. “Is this your first baby? Take some paracetamol and have a hot bath”, one was told. The sad thing is that it doesn’t even feel surprising. So many women have stories like this, even women who had “good births”.
I have a story like this: I was told that I wasn’t having contractions (my son was back-to-back in the womb, so believe me, I was) and had to demand repeatedly to see a doctor. The woman I was talking to this week had a story like this: after an examination, staff wouldn’t let her off her back, despite her pleas. My friends have stories like this: told they were not in labour, denied pain relief, subjected to interventions that they did not want. Laughed at by midwives, dismissed by doctors. The Guardian’s readers have stories like this: filling my inbox, so many that I couldn’t reply to them all.
Acute feelings of powerlessness during labour often lead to birth trauma. It’s time to face up to the fact that we are surrounded – in all walks of life – by traumatised women. Perhaps that sounds dramatic. If you don’t believe me, go to rhyme time, go to baby gym, stand at the school gate, ask the mums in your life. The walking wounded are in the library singing Wind the Bobbin Up, trying to smile like everything’s fine.
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There is a deeply embedded medical misogyny in our culture, which often combines with racism and classism. The report found that failures of staff to listen to women’s concerns during their maternity care was even more pronounced for women from Black, Asian and other ethnic backgrounds, as well as teenage mothers and those from more deprived backgrounds. We know this goes beyond Nottingham. It is time everyone starts facing up to it.
How do we create a culture of believing women? The extension of Martha’s rule – the right to a second opinion – to maternity units is a welcome change, but it still relies on a patient’s ability to advocate for themselves. It is a heavy burden to carry for Britain’s hundreds of thousands of pregnant women, many of whom will be painfully cognisant that they will imminently enter a system in which they are likely to have to fight to be heard. It shouldn’t be like this. A well-funded, humane maternity system is the bedrock of any civilised country. What is more important than compassionately supporting the beginning of life, and getting it right? We need investment: skilled staff who are valued and not overworked, who can give their patients time and empathy, and accountable management.
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The government owes it to Nottingham’s victims, and to every pregnant woman who has been belittled, gaslit and ignored, to ensure this never happens again. They owe it to all those children who won’t get to grow up, and those who are living with the lifelong consequences of birth injury. It is time to start listening.
