Birth Trauma

Thursday 19th October 2023 Commons Chamber

11:48

[Theo Clarke (Stafford) (Con)]

I beg to move,

That this House notes that many women across the UK experience birth trauma; and calls on the Government to take steps to support women experiencing birth trauma.

I am honoured to lead the first debate in the history of the UK Parliament on birth trauma, which coincides with Baby Loss Awareness Week. Today, I am calling on the Government to do more to help mothers who have suffered birth trauma.

I start by thanking the many brave women from across the UK who contacted me, after I shared my own story, to share their personal experiences of birth trauma ahead of today’s debate. I have been overwhelmed by the response to my new campaign on this issue. I am taking the time to read and respond to every single one of you, and reviewing them has been a harrowing experience. Thank you for being so courageous in sharing your stories with me. You are the reason I am here today, to be your advocate in Parliament. I know that a number of mums are here to watch the debate today, and I welcome them to the House.

I thank a number of organisations, including the Birth Trauma Association and MASIC, for all their support. My campaign began several months ago, when, following my return from maternity leave, I decided to share my own story of birth trauma. This is the first time I have ever spoken about it in Parliament, and it is probably the most personal speech I will ever give as an MP.

Last year, I had a very traumatic birth at my local hospital in Staffordshire. I had expected to have that first hour with my beautiful daughter, and imagined her magically crawling up my chest to start breastfeeding. Instead, after 40 difficult hours of labour, I began bleeding very heavily after delivery. I was separated from my baby and rushed into the emergency room for surgery. I remember the trolley bumping into the walls, the medical staff taking me into theatre, and being slid on to the operating table. I spent over two hours awake, without a general anaesthetic. I could hear them talking about me, and obviously it was not looking good. It was the most terrifying experience of my life.

[Dame Andrea Leadsom (South Northamptonshire) (Con)]

I thank my hon. Friend for addressing what is just about the most difficult subject for any woman to have to cover. I absolutely and heartily applaud her determination to raise the issue so that other mums who have had such a terrible experience can also take some comfort from it. She is doing an immensely brave thing and has the support of Members right across the House. I thank her.

[Theo Clarke]

I thank my right hon. Friend for her intervention and for her excellent work on the start for life programme to ensure that children under five get the help that they need.

It was the most terrifying experience of my life— I genuinely thought that I was going to die—so I put on the record my immense thanks to the fantastic NHS team at Royal Stoke University Hospital, who carried out my surgery, and to the midwives who were with me during labour. I thank in particular my surgeon Nitish, my midwives Michelle and Stacey, my health visitor Chris, my mental health advocate Judith, and Nicole at the perineal clinic. However, the entire experience has also completely opened my eyes to challenges in post-natal care in this country.

I remember being wheeled into the recovery ward after surgery, where I encountered a nurse who had not read her notes and assumed that I had had a C-section. I was then moved to a side room, where I was hooked up to a catheter and a drip, and was lying in bed next to my baby, who was screaming in her cot. I could not pick her up. I pressed the call button for help, and a lady came in and said, “Not my baby; not my problem,” and left me there. That is unacceptable behaviour, especially when you are extremely vulnerable. I have subsequently met the hospital trust chief executive and the chief nurse, and I appreciate their apology and commitment to providing quality, safe care to women in Stafford going forward.

I spent nearly a week in hospital. One of my main reflections was the lack of aftercare for mothers. There is so much focus on the baby that we sometimes seem to forget that the mum has had a traumatic experience and needs care, too. I had never heard of birth injuries before. I later discovered that during childbirth I had suffered from what is known as a third-degree tear, when the baby stretches the vagina and rips the muscle in the back passage called the anal sphincter, which it is vital to repair. It is important to say that, although many women will have no issues in childbirth, some will, like me, be unlucky and have a third or fourth-degree tear, which occurs in about three in 100 vaginal births. I now know that around 20,000 women a year in the UK suffer from birth injuries. The consequences of an untreated obstetric tear can include urinary and faecal incontinence, as well as ongoing pain, so it is clear that we must do more to help those women.

On my return from maternity leave, I contacted those at the Birth Trauma Association, who are here with us today, and asked them to bring some mums to visit me in Parliament. I discovered that there is huge disparity across the UK in care for mothers who have experienced birth trauma. I was genuinely shocked at some of the stories those mums shared with me. For example, Gill Castle suffered from a fourth-degree tear and now has a stoma bag, and she had to give up her job as a police officer. She has since become an amazing campaigner on birth injuries, and I congratulate her on just becoming the first person with a stoma bag to solo swim the English channel.

It was so upsetting to hear their stories following that meeting, including sad examples of babies who had died and examples of medical negligence. That is why I decided to launch a new all-party parliamentary group on birth trauma with my Labour co-chair, the hon. Member for Canterbury (Rosie Duffield), who I am delighted is here today supporting the debate. Our APPG is cross-party, and we are so pleased that many colleagues from across the House have joined us to provide support. I welcome NHS England’s commitment to addressing these issues and the fact that it has now set out a three-year delivery plan for maternity and neonatal services, published in March, but it is clear that we still need to do more to improve post-natal care.

Birth trauma is caused by traumatic events or complications in birth. It is a term that can apply to those who experience symptoms of psychological distress after childbirth or physical injuries sustained during delivery. Those can include surgical procedures such as a sudden emergency requiring a caesarean section or a long and very painful labour in a severe state of pain for many hours.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for her courage in sharing her personal story with everyone in the Chamber and those further afield. One of my staff members had an emergency C-section. It started before she was under anaesthetic, and she was unaware it was coming. The trauma of it was very real, and it is clear that she should have been offered help to come to terms with it. She left hospital with a beautiful baby, yes, but she also left with a scar and a memory of traumatic events that she could not process because she did not know what was happening, and it all came upon her very quickly. Does the hon. Lady agree that in such scenarios, counselling and help should be offered at the beginning and should be accessible for all?

[Theo Clarke]

I thank the hon. Member, and I absolutely agree. If he will bear with me for a few more minutes, I will get on to that later in my speech.

I was talking about examples of birth trauma, which can also include a premature or very ill baby, having a difficult forceps birth, or a post-partum haemorrhage with severe loss of blood. Women have told me that they felt fearful that they or their baby might die. The traumatic event can be exacerbated by unkind or even neglectful care, or when women who feel physically or emotionally damaged after a traumatic birth are expected to look after their baby without any help.

Research shows that 4% to 5% of women will develop post-traumatic stress disorder after birth, which translates into about 30,000 women a year in the UK. The diagnosis of PTSD does not just relate to mothers but can also include fathers who have been present at their partner’s birth. Many of them have told me that they were kept in the dark about what was happening to their partner and baby. Symptoms of PTSD can include flashbacks or nightmares; negative alterations in mood such as guilt, sadness or self-blame; and a feeling of being constantly anxious and on high alert.

Birth trauma is obviously compounded by the stress of looking after a newborn baby, including months of sleep deprivation. Mothers have written to me to say that medical procedures that remind them of birth, such as a cervical smear test, can induce feelings of terror. Others became so fearful of their baby coming to harm that they refused to leave the house or let anyone else hold their baby. In many cases, their relationship with their partner has deteriorated because the woman has become so distressed. Women have told me that they found it impossible to return to work due to flashbacks or because they have physical injuries that make it impossible to do their job. Psychological, as well as physical, birth trauma also occurs when the mother is separated from her baby immediately after birth, which is what happened to me, and when they are poorly treated by healthcare professionals.

I was extremely lucky that I was treated by a specialist perinatal mental health team called the Lotus Service in Staffordshire, which included trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing, known as EMDR, in addition to attending a specialist perineal clinic for my tear. I welcome the fact that NHS England is setting up regional perinatal mental health services, but I am afraid that it is still patchy, and many women still face long waiting lists for therapy. In 2014, fewer than 15% of localities provided specialist perinatal mental health services for women with complex or severe conditions at the full level recommended by National Institute for Health and Care Excellence guidance, and I am afraid to say that 40% provided no service at all.

Clearly, we must end the postcode lottery that mothers in the UK currently face. It is unacceptable to me that a mother can receive a different level of care just because of where she lives, so today I call on the Government to ensure that perinatal mental health services are available to all mums across the UK.

I turn now to post-partum psychosis, which is a serious mental health illness that can affect mothers after they have had their baby. Tragically, it affects around one in 500 mothers after giving birth. Post-partum psychosis is very different from what is sometimes called the baby blues, which is more about mild mood changes post-birth: this is a serious mental illness that is treated as a medical emergency. Symptoms can range from hallucinations to manic moods and delusions, and it can sometimes take up to a year to recover. In my constituency of Stafford, we are privileged to have an amazing parent and baby unit at St George’s Hospital, which I recently visited. It is a specialist facility that aims to provide in-patient mental health services for women experiencing psychological and emotional difficulties specifically related to the latter stages of childbirth and early motherhood.

Next, I want to highlight the recent reports into maternity care at Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham, which have all identified problems in birth that arise from inadequate care. Sadly, those reports identified problems such as understaffing, poor team working or a culture of blame, which all contributed to the very sad and avoidable deaths and injuries of mothers and babies. We also know that a difficult birth is much less likely to lead to a woman developing trauma symptoms if the staff treat her with kindness and dignity, make sure that consent is obtained for procedures, respect her wishes for pain relief, and display sympathy when she is clearly distressed.

I have spent the past few months meeting with experts in the field, including the Royal College of Obstetricians and Gynaecologists, the Birth Trauma Association, the MASIC Foundation and the Maternal Mental Health Alliance. Following this, I partnered with Mumsnet—the online forum for mothers—to conduct a national birth trauma survey, given the lack of data. Our survey received 1,042 responses. The key results showed that 53% experienced physical trauma; 71% experienced psychological or emotional trauma; 72% said that it took more than a year to resolve; 84% who experienced tears said that they did not receive information about birth injuries ahead of time; and 32% experienced notes not being passed on between shifts. These results are shocking, and we shared them recently at our first meeting of the all-party parliamentary group on birth trauma.

I was very grateful that Dr Ranee Thakar, president of the royal college, came to that meeting to talk to us about her initiatives, including on obstetric anal sphincter injuries—known as OASI—which, as I have already mentioned from my personal experience, are third and fourth-degree tears. Long-term consequences can include chronic pain, sexual dysfunction, and difficulty or inability to control the bladder, bowels or passing of wind, and can significantly affect mental health and people’s ability to carry out everyday activities. We need to break the taboo by talking about this, and that is what I am trying to do today. Childbirth has been identified as a key risk factor for the development of pelvic floor dysfunction later in life, with one in 12 women having a pelvic organ prolapse.

To reduce the likelihood of birth injuries, UK experts led by the royal college created the OASI care bundle, which has already been rolled out in 19 new maternity units since 2019. That care bundle has been significant in reducing birth injuries by 20%, so today I call on the Government to roll it out across NHS England to all hospital trusts. I also put on record my thanks to Mr Speaker for extending my proxy vote after my maternity leave, in order for me to recover from my own birth injury. This new system of remote voting will make a huge difference to MPs who are new mothers or have had to undergo major surgery, as I did.

Sadly, ahead of today’s debate I have been inundated with hundreds of emails and letters from mothers who have experienced birth trauma. I thank each of those, and in some cases the partner, who have taken the time to write. I know how difficult and painful it is to talk about this. With their consent, I will briefly share some stories that I believe powerfully highlight the issue.

One mother, who gave birth in Leicester General Hospital, writes:

“I delivered my son naturally and without intervention, but I did suffer a third-degree tear. This wasn’t really explained to me at the time, other than to tell me that I needed stitches. It was only afterwards, when I received a copy of the consent form, that I realised exactly what the surgery had been for.”

Another mother writes:

“Labour was progressing well, then I started to…tear, so an episiotomy was performed. But I had torn all the way to the back, I was taken into theatre for repair…which took nearly 2 hours. I lost about 1 litre of blood… Currently I experience pain and bleeding after bowel movements, pain during sex”

and, as we can imagine, a

“smear test several months ago was agonising”.

She said she had been

“experiencing nightmares, awful intrusive thoughts and panic attacks, all concerning leaving or being separated from my son”,

and she was referred to her GP for post-traumatic stress disorder.

A mum called Stacy says:

“I was told I’d either need forceps or a C section so would be taken to theatre. I couldn’t read the form I was so out of it and I remember my signature sliding down the page”.

Another writes:

“I suffered birth trauma, feeding issues, bad medical advice, poor mental advice, long term sleep deprivation”,

and even PTSD was triggered in her husband.

Sadly, there have also been examples of inequalities in treatment among ethnic minority groups. One mother explains that

“the nurse did not spot my haemorrhage due to the colour of my skin. There needs to be more diversity training, as the medical professionals fail to recognise symptoms in non-white patients”.

Finally, an NHS doctor who served as an obstetrician wrote to me to say:

“Occasionally it was dads who were traumatised. Watching your partner experience a major obstetric haemorrhage and literally being left holding the baby whilst she is being wheeled away from you into the operating theatre was…a distressing experience and as time went by the dads were sometimes left wondering if they might be bringing up the baby as a single parent. Everyone was busy with their wife in theatre and no one came to speak to them for quite some time”.

Unfortunately, none of these are isolated incidences—they occur all too frequently—so the Government must take action to improve the experiences of women who have traumatic births.

I welcome the fact that the Department of Health and Social Care published its 10-year women’s health strategy for England last year. I also welcome the appointment of Professor Dame Lesley Regan as the Government’s first ever women’s health ambassador for England, and I look forward to meeting her in a few weeks’ time. However, on reviewing the Government’s strategy, I was surprised to find the mention of birth trauma only once in the entire document, which was in the context of a call for evidence for the public inquiry. Given that the public in their response to the Government’s strategy included a request for birth trauma, it is now essential that this is delivered in any future updates to the women’s health strategy. So today I am calling on the Government to add birth trauma to the women’s health strategy in a meaningful way.

Lastly, I want to touch on staffing. We know that our brilliant NHS workforce is essential to ensuring safer and more equitable maternity services. This has been recognised in both the Ockenden and the East Kent reports. We know that safe staffing levels are essential to the provision of safe maternity care, and we also know that workforce recruitment remains a priority concern. I note that NHS England’s long-term workforce plan has set out commitments to support our maternity and neonatal workforce, but unfortunately staffing gaps remain, with an 11% vacancy rate.

In conclusion, it is so clear to me that so much more needs to be done to support women who experience traumatic births. Today I call on the Government to add birth trauma to the women’s health strategy; recruit more midwives; ensure perinatal mental health services are available across the UK; provide appropriate and mandatory training for midwives with a focus on both mental and physical health; ensure that the post-natal six-week check with their GP is provided to all mothers, and will include separate questions on both the mother’s physical health and her mental health in relation to the baby; improve our continuity of care so there is better communication between secondary and primary health care, including explicit pathways for women in need of support; provide post-birth services nationally, such as birth reflections, to give mothers a safe space to speak about their experiences in childbirth; roll out the obstetric anal sphincter injury care bundle to all hospital trusts in England to reduce the risk of injuries in childbirth; provide better support for partners and fathers; and, finally, have better education for women on their birth choices and on risks in order to ensure informed consent.

Let me thank all the birth trauma organisations and the mothers who have contributed to this campaign. I really hope that the Government will listen to my plea today, and ensure that women who suffer from birth trauma will now receive additional support.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I congratulate the hon. Lady on her opening speech, which I am sure was very difficult to make but was extremely brave. I will certainly pass on her thanks to Mr Speaker regarding her proxy vote.

12:10

[Rosie Duffield (Canterbury) (Lab)]

First, I wish to thank my lovely hon. Friend the Member for Stafford (Theo Clarke) for securing this debate, for setting up the all-party parliamentary group for birth trauma, for her brilliant speech and bravery, and for generally allowing me to ride chaotically on her incredibly organised coattails.

What is birth trauma? The Birth Trauma Association describes it as

“a broad term applied to those who experience symptoms of psychological distress after childbirth. It includes those whose symptoms qualify for a diagnosis of post-traumatic stress disorder.”

That term certainly applies to the many women who took part in our recent Mumsnet birth trauma survey, which included some statistics that should be of concern to all health professionals, and some shocking stories of women’s experiences. It also certainly applies to those women in east Kent whose experiences contributed to the damning Kirkup review, which was released a year ago in October 2022.

Women who had every right to expect safe and professional care during their pregnancies and labour were badly let down by our health trust, often with life- changing consequences. The poor, sub-standard maternity care received by many families over an 11-year period made for extremely harrowing reading, and I take this opportunity to thank Dr Kirkup and his team for their painstaking work, and for their sensitive and caring approach to the women and families over the course of their investigation. I know that they continue to make themselves available to anyone who may need them, which is in stark contrast to the scandalous way in which those families were often treated at the height of their trauma, and as they struggled to come to terms with what they had been through.

No matter what analysis of each individual case of birth trauma or the findings of reports conclude, one basic requirement should be unchanged in the hospital experience of every single patient: care. Kindness, good manners, information, listening to women—those are not things that should be altered or affected in any way by medical circumstance or emergency. Are such things not in fact even more vital when a panicked or distressed family are faced with a traumatic situation? The way that my hon. Friend was spoken to after her unexpectedly difficult birth—I should not need to stand in this place and explain that it was unacceptable.

For my constituents in East Kent Hospitals University NHS Foundation Trust, which is chronically short-staffed and plagued by low morale and a lack of equipment, those factors definitely contributed to some of those terrible experiences. Basic patient care standards should always apply, and essential staff, no matter how lowly their place in the chain of command, must always be afforded respect by those in authority so that they feel supported and, crucially, are able to raise concerns without the real fear of repercussions.

During the Kirkup inquiry, much of my team’s work was speaking to staff who wished to be contributors but were extremely afraid of speaking out. One midwife went to great lengths to remain anonymous, even buying a burner phone in order to call me in my office. She was very upset and nervous but helped me a great deal by providing background information. Why should a whistle- blower have to be so afraid when her testimony could help to improve standards and practices in our NHS?

The Minister recently attended a discussion with some of the families and mothers who contributed to the Kirkup review in my constituency. I know they felt that she listened and had direct contact, which was so important to them. Their experiences should make every Member here, and every member of East Kent Hospitals University Foundation Trust, determined to improve every aspect of maternal care in our region.

In his “Reading the signals” report, the overriding and most important point that Dr Kirkup stressed was simply, “Listen to women.” Yet those I am still in contact with, although grateful for the acknowledgement and involvement of the Minister and our trust’s new CEO, Tracey Fletcher, still do not yet have faith that services have improved dramatically. Whenever family or my staff members use maternity services in East Kent, I tell them to ensure that their relationship to their MP is mentioned. That should not be something I have to do in order to feel that they might be safe and looked after.

I want to make time to read out direct comments from some of the mothers and families involved in that inquiry, and especially from my former constituent, Helen Gittos. I thank her for her tenacity, her courage, and for continuing to raise issues with me on behalf of those affected. I will end by reading out Helen’s thoughts, emailed to me late last night, as I think that her voice in this debate is far more important than mine. She says:

“Some of the strongest comments tonight have come from those families who are caring for very disabled children. It was Amie Taylor who said this, ‘Personally, I would love them to understand that this has had a profound effect on us all in more ways than seems to have been acknowledged by the Trust, or maybe even the report, from somebody who had a baby with a brain injury following sub-standard care. We are faced with ongoing medical issues and the strain mentally, physically, emotionally, financially, and what may be the other side of this, hasn’t been acknowledged. The impact this has had on our careers, family dynamics, social life—every element of our lives were affected. PTSD, anxiety, depression. I am pretty sure all the families have experience in one degree or another of this.’”

[Jane Stevenson (Wolverhampton North East) (Con)]

My constituent, Tracie Reynolds, lost her daughter Trinity in New Cross Hospital in Wolverhampton 20 years ago, and she has been campaigning on maternity services and indeed has met the Minister. Let me put on record my thanks to my hon. Friend the Member for Stafford (Theo Clarke) and the hon. Member for Canterbury (Rosie Duffield) for bringing forward this debate. I know so many mothers who have struggled, and I wanted to place on record the thanks of my constituent, Tracie, in memory of Trinity and all the babies who sadly are not here. My hon. Friend and the hon. Lady have done an immense service to so many people by bringing forward this debate.

[Rosie Duffield]

I thank the hon. Lady very much.

Helen goes on to say:

“Staff in the Trust and women with very recent experience say that there has been no real change. One woman said on the Facebook Support Group tonight ‘Having had my 6th baby at William Harvey Hospital this August I can say very little has changed 1 year on’.

What we have seen so far is action plans but not actions—exactly the kind of checklist, tick-box exercise Bill Kirkup said doesn’t work. I and others do not think the core messages of Reading the Signals have been understand—let alone acted upon. Clinical leadership is absent. New Head of Midwifery and her Deputy seem excellent but the doctors are just not present—they are not writing the action plans, not attending the Reading the Signals Oversight Group meetings, just really absent. How can the Government say that they accept the findings of the report when NHS Resolution—who act on their behalf—are not accepting the findings?”

The Minister and I heard that when we spoke directly with those families. Helen continues:

“How can the Trust say that they are concerned about patient safety when lawyers acting on their behalf continue to behave appallingly at inquests? In the case of Archie Batten they tried to argue he was stillborn and therefore there should be no inquest. In the case of Maya Siek in September, they argued there was no need for it to be an Article 2 inquest.”

That comes up time and again, as the Minister knows. Those women want the law to be changed so that stillborn births have to have an inquest.

Helen says:

“One family involved in this said on the Facebook group tonight: ‘Personally, I would love them to understand that this has had a profound effect on us all in more ways than seems to have been acknowledged by the Trust, or maybe even the report”.

I earlier mentioned that her child had a brain injury. Helen continues:

“Another simply said this: ‘This last year has caused so much turmoil for so many I hope that comes out somewhere.’ I think that really captures the experience of so many people involved—and that turmoil has been partly because people’s experiences of engagement with the Trust continue to be so problematic. But I think the Kirkup report provides us with a plan. And that rather than get side-tracked into an expensive, time-consuming public enquiry, we should all put our collective effort into enacting its recommendations. If we did, things would get better.”

I thank the House for its indulgence; this is a really upsetting debate.

12:20

[Douglas Ross (Moray) (Con)]

It is an honour to follow the hon. Member for Canterbury (Rosie Duffield). I congratulate my hon. Friend the Member for Stafford (Theo Clarke) on how she introduced this debate and her bravery and courage in articulating her own case and also those of many others in the Chamber today and watching at home. My hon. Friend mentioned some of the figures that came out of the Mumsnet survey into birth trauma, and one of the most stark for me was that 79% of women have experienced birth trauma. At what should be and often is the happiest time in our lives as parents, to go through that trauma is unacceptable. For so many to do that is incredible.

Another issue that I thought was important was the number who felt they were not listened to, which comes up time and time again. One says:

“I know 100% I was not listened to, because my husband was there begging for them to listen, and he was refused point-blank and told to go away, because I was just ‘freaking out because I was hormonal and pregnant’.”

That kind of care is unacceptable. The fact that so many women at that vulnerable stage feel that they are not listened to is shameful. I was particularly reminded of that when I saw and heard the spontaneous applause and ovation following my hon. Friend’s speech. I now feel that the women in the Gallery and the mums are being listened to. They are being listened to in our Chamber today. It is a shame that this is the first time this matter has been debated in our Parliament, but the work of my hon. Friend and the hon. Member for Canterbury together across parties has ensured we can have a debate today. That means, I hope, that more and more women will feel listened to on this important subject.

I will speak about birth trauma from a local constituency point of view and in the context of the downgrading of our maternity hospital at Dr Gray’s in Elgin. I have raised it many times. It is certainly not the levels of trauma that my hon. Friend the Member for Stafford has experienced and articulated, but it is a trauma that too many of my constituents go through. I will articulate some of their cases. In 2018, Dr Gray’s maternity unit was given a temporary 12-month downgrade. Here we are in October 2023, and I am still as the MP for Moray raising concerns that we do not have a full consultant-led maternity unit back up and running. It means that any woman who is not on a green pathway has to travel to either Aberdeen or Inverness in the most trying of circumstances to give birth.

I will briefly mention our own experience. We have two lovely boys: Alistair and James. Alistair was born in Dr Gray’s. He was on a green pathway and everything was fine. The care at Dr Gray’s was exceptional. Our second son, James, was born in 2021, and he and my wife were on a green pathway right up until the moment she went into labour. We went in to see the midwife in Elgin just as the labour was starting, and she just was not comfortable; there was something I picked up, and I was not being told everything. They just were not 100% happy, so they said, “Go up to Dr Gray’s and just see how things are progressing.” I knew if anything went wrong, we would be going to Aberdeen, because I had been dealing with far too many of these cases as the MP. I always felt that, luckily, I would not experience that, because Krystle had been on the green pathway with both Alistair and James.

Things clearly were not right, and we were told at one point that James’s heart rate was dipping. As soon as you hear that as a parent, you start to worry. I am not medically trained, but when told that the heart rate of a baby who is about to be born is dipping, and that there is worry about contractions, parents immediately start to worry. We were reassured by the teams in Dr Gray’s, but then we were told that we would have to transfer, which was my nightmare. I had been raising questions about this issue in Holyrood with Scottish Government Ministers, who responded very well, and I had raised it here. The journey from Elgin to Aberdeen is 70 miles on a not particularly good road. I remember being told that we would do an emergency transfer: Krystle would be put in an ambulance and I would go in the car through to Aberdeen.

I do not get particularly emotional, but that walk with my wife on a trolley from the maternity suite in Dr Gray’s, where I hoped our second son would be born, through the hospital to an ambulance was one of the worst I have ever experienced in my life, because I knew those were the last few minutes I would be with my wife before she was put in the back of an ambulance to travel separately from me to Aberdeen. She got strapped in. I cannot imagine what it is like having contractions strapped on your back in the back of an ambulance, facing a 90-minute journey through to a hospital to give birth, knowing that the child inside has problems with a dipping heart rate. But I had to leave her; I could not be with her at her most vulnerable time. She was put in the back of the ambulance, and I was told to go straight away, because the ambulance obviously had blue lights and could get to Aberdeen far quicker than me.

I left with the doors closed, got in the car and I kept looking in my rear-view mirror, thinking, “Where’s the ambulance?” I passed Lhanbryde, Mosstodloch and Fochabers and there was still no ambulance. Then it started to hit me, “What if they had to pull over? What if something has gone wrong in the back of the ambulance?” We were warned about that, and I had been raising that on behalf of constituents. The ambulance never came. I was going up the Dramlachs between Fochabers and Keith, and I suddenly saw the blue lights in my rear-view mirror, and I have never been happier in my life, because I knew at least she was still progressing through to Aberdeen.

To cut the story short, we got to Aberdeen. I could not find the maternity suite. It is a big hospital. Dr Gray’s is easy to navigate; Aberdeen is not. Our son was born safely and healthily, but that is a journey that no mother in labour should ever have to make, and no father or family member should have to follow the ambulance. My hon. Friend said that often fathers were kept in the dark. I have never felt more in the dark than during my 90-minute drive to Aberdeen on my own, worried about what would happen to my wife and child. This has been going on for far too long. A temporary downgrade for 12 months was bad enough; for it still to be happening in 2023 is shameful and unacceptable, and I will always stand up in this place and at Holyrood to call for Dr Gray’s to have a full consultant-led maternity unit.

The last case I want to articulate is that of another constituent who gave birth this year. I will read out her birth story, because it goes to the heart of birth trauma. There are elements around surgery and what my hon. Friend so bravely articulated that are unacceptable, but the birth trauma in this case is equally unacceptable and has had a long-term impact on my constituent. She wrote on the local Facebook page for the campaign group, Keep MUM, which does outstanding work. It is the group that got the maternity unit established at Dr Gray’s many decades ago. Marj Adams led that campaign, and she is now, with her daughters, leading the Keep MUM campaign to get it reinstated. It has an excellent Facebook page that shares these stories. The mum said:

“I was lucky enough to have my first baby at Dr Gray’s in 2020, two years after the unit was downgraded. Although the fear of transfer was high at all times, the actual experience of being able to labour at home for as long as possible and make my way into the hospital when I felt ready which is five minutes’ away from my house was amazing.

I had my second baby in 2023 and, due to last minute complications, I was told I had to give birth in Aberdeen. On the morning that my contractions started, I phoned Dr Gray’s and was advised to make my way through to Aberdeen asap as it was my second pregnancy and, because of this, they wouldn’t turn me away. We drove through, I was contracting the whole way there, which was horrible.

When I arrived at Aberdeen and was examined in triage, I was told I was only 2 cm so would need to go home as ‘women labour the best at home’. I explained that I was from Elgin and this wasn’t possible as it’s a 4-hour round trip and this is my second pregnancy and I progressed quickly with my first pregnancy.

They then advised that we would need to book a hotel as we couldn’t stay at the hospital as they don’t have space.”

So a mum in labour who had been told by Dr Gray’s to go to Aberdeen and that she would not be turned away, was being turned away. She continues:

“So we frantically tried to find a room to book and managed to get one just down the road from the hospital, but check-in for the room wasn’t until 3pm, and by this point it was only 12 pm. We asked if we could stay a few more hours at the hospital and we were told ‘no’.

I was then contracting heavily in the hotel car park, my waters had gone and were leaking everywhere and I was crying my eyes out feeling so scared and uncomfortable. I phoned the hospital back around 2 pm and explained that the contractions were a lot stronger and closer together and asked if I could come back in, but they said they didn’t have space for me so I could only come back in at 3pm. So I waited for another hour and, by the time I got to triage and was examined, I was 7-8 cm. My baby was born 30 minutes later.”

The mum finishes by saying:

“The whole experience was awful and felt inhumane. I had several panic attacks throughout and afterwards and I still feel panicked when I think about it now.”

She could not give birth close to home as she wished. She had to drive through a horrendous journey from Moray to Aberdeen. She was turned away by a hospital. Her waters broke in a hotel car park where she was seeking refuge before she went into labour, and her baby was born just 30 minutes after finally being admitted to the hospital.

The hospital and NHS Grampian have rightly apologised for the appalling way in which they treated my constituent, this mother. The trauma that she went through and the fact that it still affects her shows that today’s debate is important; in it, we can articulate in this place the concerns of our constituents. I have been proud to be part of the debate and to listen to outstanding contributions from colleagues. I hope that mums here in Westminster and watching from home feel reassured that their parliamentarians across the House will stand up for them to ensure that these birth traumas can be minimised and hopefully be completely ruled out in future. It should and must always be the happiest time of our lives to bring new people into this world. It is a shame that too many people continue to suffer from birth trauma. Let us do everything we can to reduce it.

12:32

[Helen Morgan (North Shropshire) (LD)]

I thank the hon. Members for Stafford (Theo Clarke) and for Canterbury (Rosie Duffield) for bringing forward the debate. The hon. Member for Stafford gave an excellent speech; it was brave but also extremely thorough. Given that a similar debate will follow shortly, I will restrict my comments to one specific area: my experience of having a baby. That was nearly 15 years ago, which is quite a long time ago, and I am pleased to report that my baby is now a healthy young man who is already significantly bigger than me. But my experience of his birth, and specifically the attitudes to the use of a caesarean section both generally in society and in the medical profession caused me concern.

I was induced at 12 days overdue at about 9 on a Friday morning, and my baby was delivered by emergency caesarean just before 10 on Saturday night, which I think we can all appreciate was quite a long time later. Various professionals looked after me during that time. They were invariably caring, humorous and competent. They had a good laugh at my birth plan and chucked it away and, when they had given up all hope of what they described as a “natural delivery”, I was wheeled across the corridor to a theatre and had the necessary procedure. That all went very well. I was very tired but happy and luckily my baby was making his views on the situation known at enormous volume. I was sent home after just a few days’ stay in hospital.

It was after I got home that things started to feel different for me. People kept expressing sympathy. The final straw was when a health visitor asked if I felt like a failure for having had a C-section. The answer really was, “Not until somebody suggested that maybe I should.” The medical evidence is clear that, if a vaginal delivery is possible, it is usually a superior option. I am not here to deny that, but I do think that we should take a look at attitudes to women who have had or needed a C-section because that was medically the best option for them.

I have a degree in history and chose to specialise where possible in medieval and early modern social and economic issues. I hope to God that my in-depth knowledge of the societal impact of the bubonic plague is never useful to me, but after my baby was born I found myself reflecting on historians’ best estimates of maternal and baby death in that era. It is possible that one in 10 pregnancies ended in the death of the mother, and the proportion of babies who died in those early days was obviously far higher. At the time, I found the reflection that, even 200 years ago, probably neither me nor my son would have survived extremely sobering and shocking.

Surely, given the amazing advances in modern medicine, we should celebrate that that is a statistic firmly consigned to history. Surely the only important objective when you arrive at hospital in excited anticipation of the arrival of your baby is that both you and your baby leave that hospital in a healthy state. I am afraid that the expectations of pregnant women are greater than that—that real women are expected not to rely on medical advances that have saved millions of lives over the last couple of hundred years but to have their baby without pain relief and without intervention, if possible without making too much noise—and definitely enjoying an empowering moment. Obviously that is total garbage: you are at your most vulnerable, both physically and emotionally, and then after what is potentially a traumatic and painful experience, you start the endurance test of caring for your new-born baby on zero hours’ sleep for probably the next four or five months.

Personally, having failed at being an earth mother, I found the first year of motherhood very difficult. I was sleep deprived and attempting to feed the world’s hungriest baby—this was not the fairy tale that I had imagined at all—but I was doing better than some of my friends. One friend had had what was described as a “natural” delivery. Her baby arrived six weeks before mine, but the consultant apparently did not like C-sections. Her baby was delivered in distress with forceps. She suffered terrible tearing and, in the end, despite my having undergone major abdominal surgery, I was discharged before her. I am not an expert, but at the time it seemed to me that a C-section may have been a better outcome for her.

Another friend suffered a long and uneventful labour similar to mine. Again, the consultant did not like C-sections, so she ended up delivering her daughter with a last-minute smash-and-grab with a pair of forceps. Her baby was resuscitated on arrival and removed to the special care unit. My friend suffered flashbacks for years afterwards. Compared with that—I could not drive for four weeks, but overall I felt okay—I felt that my experience was superior. I was therefore particularly horrified when the Ockenden report was issued last year to see that a reluctance to perform C-sections was one of the factors in the failings of the Shrewsbury and Telford Hospital NHS Trust. In fact, it was generally considered on a nationwide basis to be a huge success not to use this lifesaving option wherever possible.

There are undoubtedly women who have experienced unnecessary trauma or worse because of a reluctance to use a C-section. I fear that what lies behind that reluctance is a failure to listen to women when they are having their babies and when they know what options would be best for them at that time. We celebrate advances in modern medicine and advances that save lives. I am not entirely sure why we do not fully celebrate the advance of a C-section. As I said, the objective when a woman is having her baby is to ensure that they both leave the hospital and arrive home in as good a state as possible. We must urge everyone in society and in the medical profession to ensure that that is their top priority.

12:38

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

First, I thank my hon. Friend the Member for Stafford (Theo Clarke) for securing the debate, and I thank her and the hon. Member for Canterbury (Rosie Duffield) for establishing the all-party parliamentary group on birth trauma. I co-chair the all-party parliamentary group on baby loss, and it is surprising, and remiss of us, that we have never focused on birth trauma as part of the work of that all-party parliamentary group. That could be why it did not feature heavily in the Government’s women’s health strategy. I am therefore thankful that my hon. Friend has brought the subject to Parliament front and centre and that we are talking about it.

I pay particular tribute to my hon. Friend for sharing her story. It was three years ago in my first Baby Loss Awareness Week debate that I stood in Westminster Hall and told my story, not realising how much it gets to you when you are speaking in a very quiet Chamber and in public. I was thankful to colleagues for intervening on me on that day so that I could just get through. So I understand exactly where she is today and think she has been incredibly brave. I hope that she continues to use the force she has inside her for good.

I also thank the hon. Member for Canterbury, who is clearly a powerful advocate for her constituents. It is appalling that her friends and family need to drop her name as they go to hospital for what should be a routine procedure—if we want to call labour a procedure. I am sorry that they have to do that, and I hope that the voices in this place will mean that that will not be case for much longer.

I thank my hon. Friend the Member for Moray (Douglas Ross) for highlighting what is a difficult time for dads. Listening to his speech made me think that, when we lost our baby, even though my husband was with me all the time, they did not ask for his opinion at all. Had he not been there, would they have done? I am not sure. I thank my co-chair of the all-party parliamentary group on baby loss, the hon. Member for North Shropshire (Helen Morgan), for her collaborative work on all things baby loss, and for sharing her story. She highlighted how dangerous labour and birth is. It has never been safe. We just did not evolve very well as a species in that regard. It is thanks to medical advances that we save as many babies and women as we do today in this country.

[Rosie Duffield]

Does the hon. Lady agree that the scandal of maternal deaths among black and ethnic minority women is especially horrific? We need to work with groups such as Five X More and highlight that in this place as often as we can, to end it as soon as we can.

[Cherilyn Mackrory]

I absolutely agree. We have done some work and a few inquiry sessions on that in the all-party parliamentary group. The disparity is outrageous. The Government are trying to put in place plans such as continuity of care, which I will come to. It is a particular passion of mine and I will speak about it a little later.

Since becoming the Member of Parliament for Truro and Falmouth, I have made it my mission to champion as many women’s health issues as I can, particularly baby loss. I have often talked in this place about what happened to me, though I will not go into my story today for fear of not being able to get through my speech. We have just had Baby Loss Awareness Week, which we will talk about in the next debate. Tackling often avoidable birth trauma is an integral part of that mission. Bringing life into this world is the most precious thing. Where women have unfortunate experiences, we must make sure that adequate measures are in place to support them and the mental health of their families. I thank all the women who have come today to support my hon. Friend the Member for Stafford and the work she has done for every one of them. It is a brave move to come forward and talk about your story, let alone collaborate, come to this place and advocate for other women who are watching at home. I thank them.

Every woman is different. The freer the flow of information between mothers and their doctors, the more tailor-made and informed the health provision can be. I am reassured that work has started in this space to start to empower women through informed maternity decisions. We have outlined that in documents such as the “Safer Maternity Care Progress Report 2021” and further progress reports over the last two years.

I have been particularly reassured and impressed by the engagement of our Minister through the various all-party parliamentary groups on women’s health. Let me take this opportunity to thank all colleagues who have been involved in boosting maternity issues. We are lucky to have a Minister who understands this area completely, having worked in the sector. She does all she can to keep us informed of developments, and when we do not get things right, she takes it on board.

Delivering a more informed maternity provision in our hospitals has the potential to reduce birth trauma caused by inappropriate methods of birth for a specific mother with specific needs, which is even more important when considering that seven in 1,000 babies born to black mothers are stillborn. If we are able to provide evidence-based information to mothers from all backgrounds on what options best suit their needs, we will undoubtedly get to grips with the inequalities in pregnancy outcomes.

In my role as chair of the all-party groups I mentioned, I have heard so many stories from women about their experiences. Some are simply traumatic and some should never be allowed to happen again. When my hon. Friend the Member for Stafford told me she would come forward with her story and had the fire inside her to start a campaign, I gave her a word of warning from when it happened to me. You tell your story once, and you think you can pack it away until you need to think about it again. When you are constantly talking to other people who have been through a similar thing, you are constantly thinking about your own experience as well. Some days you can put on a front, put your armour on, get through it and be that shoulder for them to cry on. Other days it is not as easy. My advice to anyone who has been through it is to look after yourself first, please. You cannot look after others unless you have looked after yourself.

In so many of these stories, women talk about their excitement for what is to come, and the search for answers afterwards when things go horribly wrong. We have a duty to make sure that every time an expectant mother visits a hospital, midwife or local GP, they receive full and proper advice from someone who is fully informed about their case. That is why I come to continuity of carer. It has been proven to work. In areas of the country where we have high numbers of mothers living in social deprivation or ethnic minority mothers, it has already been put into practice by the Royal College of Midwives and various health trusts. We know that it works, but the problem at the moment is the lack of midwives to roll it out nationwide. The Minister is alive to this; she understands it. We are seeing more young people going into midwifery. We have a lot of first-year students at the moment. I am pretty confident that in the years to come we will start to see more midwives deployed on wards, and continuity of carer will start to become a reality.

Really, the message is simple to any healthcare professional: just listen to women. Listen to those who advocate for women when they are in labour. Just listen. If you can, listen rather than think you know what is going on. Taking a step back, listening to what is happening and having a conversation rather than rushing and panicking often leads to a better outcome.

My hospital, the Royal Cornwall Hospital in Treliske in Truro, has improved its maternity care a lot in the last 10 to 15 years. We are also getting a new women and children’s hospital as part of the new hospital programme. Thanks to those two factors, unlike other parts of the country we have no midwifery vacancies in Cornwall. Not only that, we have a waiting list of people wanting to be midwives. I pay tribute to Kim O’Keeffe, the chief nurse officer and deputy chief executive of the hospital, and all her team, for their relentless work in this space. They are working in a decaying building at the moment, but even so we are in a much better place than we have been. The women in Cornwall who are to give birth are in a much better place than they were 10 to 15 years ago.

I want to put on record just how desperate birth trauma is. Even a healthy birth—like my first birth—is a shock if you are not expecting it. It is something that happens to you; you have no idea what is happening. Even afterwards, if it is all fine, you think, “My God, what just happened?” It is a shock that can still bring on post-natal depression, because of the relentlessness of looking after a brand-new baby. I have had two pregnancies and two births: one straightforward live birth, and the second a stillbirth. That was a straightforward birth physically, but mentally completely traumatic, because I knew I was giving birth to my baby who was not alive. I had to recover from that and grieve, and I knew what was wrong: my baby was not well enough to survive. The shock was over a whole weekend rather than a matter of hours.

We have heard stories today, and I will briefly tell the story of someone very close to me. She was seen as low risk, rushed into hospital and the baby was stuck in the birth canal. She was rushed in for an emergency section. Her husband was nowhere to be seen, because he was sidelined. There was a loss of blood. It took my friend six years before she would fall pregnant again. Luckily, she has a new baby—a little brother—who was born last month. She was frightened all the time about premature labour and whether it could happen again, and whether she should get pregnant again. After my stillbirth, I was too scared to get pregnant again, and I already had a daughter so I did not. It is different for every woman and family; there is not one fix for everyone.

I go back to my previous point that we just have to listen to women. All the services around maternity, during labour and afterwards, including counselling services, must be there because the woman—or the birth partner, the dad—has asked for them. Some women will sail through everything and be fine, but some will not. We need to ensure that, regardless of what they ask for, we are listening.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the SNP spokesperson.

12:49

[Kirsten Oswald (East Renfrewshire) (SNP)]

It is a real privilege to follow such a powerful speech by the hon. Member for Truro and Falmouth (Cherilyn Mackrory). I put on the record my gratitude to the hon. Member for Stafford (Theo Clarke), who opened the debate. She has my utter admiration for her bravery in coming here and sharing her experience. It must have been extremely difficult, but she got her important points across none the less. All the speeches today have been powerful.

It is important that we discuss the significant trauma that too many women experience. It can be caused by a whole range of things, as has come through powerfully. There is no one-size-fits-all formula, as the hon. Member for Truro and Falmouth pointed out, but that is all the more reason for us to take seriously the shocks and trauma that can follow birth.

Let me also record my great admiration for the tireless, immense and important work of my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson), who has just made an unscripted arrival in the Chamber, to support women affected by the terrible trauma of stillbirth and baby loss.

Research shows that 4% to 5% of women who give birth develop post-traumatic stress disorder. We have heard about the Birth Trauma Association’s vital work to convey the difficulties for women and, indeed, fathers—partners. I was glad that the Royal College of Obstetricians and Gynaecologists provided a briefing for the debate, in which it talks in detail about some of the challenges that people face. Up to 9 in 10 first-time mothers who have a vaginal birth will experience some sort of tear. We have heard in detail about some of the significant injuries and traumas that can happen. We must not underestimate the impact of those and other traumas. The hon. Member for Stafford set out clearly the broad range of trauma with respect to both the physical and the mental wellbeing of mothers, as well as the long-term impact of lots of the traumas that women experience.

Like other speakers, I have been contacted by a number of women who wanted to share their story. I will concentrate on one particular story, which dates back to 2006. The woman who was in touch with me described her experience as “horrendous”. As far as she and her partner could see, things had been going along smoothly, everything was planned, and they were not made aware of any risk factors, but things started to go wrong. She experienced an unconsented “stetch and sweep” of the cervix—“while I’m in there anyway” was how it was put to them. She correctly asks how many patients in any other circumstance would feel that it was okay for a medical professional to perform an additional unconsented procedure just because they were in that area of the anatomy anyway.

Of course, such utter lack of care is not the norm—all the great NHS staff who work in this area have my admiration—but in the small number of situations in which it occurs it can have a big impact on women. The lady who was in touch with me said that the pain she experienced during the birth was

“visceral, white-hot soul destroying misery.”

She was unable to return to work because of the impact and she needed further time off for surgeries. She eventually received a diagnosis of PTSD. She pointed out that women are not listened to, a point that others have made and one that I will come back to, but she also pointed out the long-lasting impact of her experience. As well as looking forward to the children who were delivered going forward into adulthood, she and her partner are still looking back on that trauma, which continues to have an effect on their lives.

I have not experienced what that lady did. I am fortunate that the emergency caesarean section that I had was one of the calmest experiences of my life—that is my good luck, I think—but I remember how acutely vulnerable I felt giving birth and being in hospital. I do not know how I would have coped with the additional challenges that we have heard about today.

I am glad that we have heard about the particular challenges faced by black and Asian women. Statistically, they face significantly more challenges, including the greater number of women who die during pregnancy or shortly thereafter. Significant work is needed on that. We cannot just shake our heads at the statistics; we need to make sure that they lead to action.

It is probably timely also to mention the worry that I am sure we all feel for mums and expectant mums in places in the world where things are much more challenging. I have no doubt that we are thinking of the mums in Israel and Gaza who are dealing with the most challenging of situations.

The hon. Member for North Shropshire (Helen Morgan) spoke about how we are expected to grin and bear it in the situations that we have been discussing. That is absolutely unreasonable, but there is a narrative in some quarters that this is just what women have to put up with and they should just take it. I do not think that that is acceptable at all. As a number of Members said, we need to listen. The hon. Members for Moray (Douglas Ross) and for Truro and Falmouth made that point eloquently.

I spent yesterday at the Women and Equalities Committee talking about women’s experience of not being listened to in the context of their reproductive health. The impact of that on women’s lives can be profound and last many years. We are dealing with the very same situation here. Most of the time, women give birth in an uncomplicated and unchallenging way, and things go well. We are grateful for that. But often enough, things do not go the way that they should. One key way that we can make that better is by actively listening to women and taking their opinions into account, given that the care for them and their children will be impacted.

[Madam Deputy Speaker]

I call the shadow Minister.

12:57

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I thank the hon. Member for Stafford (Theo Clarke) for securing this important debate. I know that she has worked hard to raise this issue both in the Chamber and through her work outside it. I want to express my deep admiration of her for sharing in public such a moving story about a terrifying experience. That takes a lot of courage.

I thank my hon. Friend the Member for Canterbury (Rosie Duffield) for her kindness and congratulate her on her work on the newly launched all-party parliamentary group for birth trauma. I know that it will be successful and productive. I thank the hon. Member for Moray (Douglas Ross) for sharing his personal story and being an ally. He rightly said that it is shameful that this is happening in 2023, and that is linked to what my hon. Friend the Member for Canterbury said about how her friends and family have to name-drop her before they can get the support that they deserve. I thank the hon. Members for North Shropshire (Helen Morgan) and for Truro and Falmouth (Cherilyn Mackrory), too, for sharing their stories. I also thank the mothers with experience of this issue who are watching in the Chamber, and organisations that are working really hard on the issue.

This has been a very constructive debate. As we have heard, birth trauma is a difficult experience for anyone, but it has been in the shadows for far too long. It is right that we are speaking about it today and making it clear to the Government and all Members of the House that there is progress to be made. Pregnancy, birth and becoming a parent can be a special and rewarding time for many people. It is the start of an exciting journey into parenthood and a time to celebrate new life. However, it is clear that, at a moment of such importance and sensitivity, when complications occur the right support does not always follow. The statistics on maternity outcomes lay bare the problem that we face. The level of support is down, satisfaction is down, and confidence and trust in the system is down.

The Care Quality Commission’s “Maternity survey 2022” reported that women’s experiences of care had deteriorated in the last five years. The proportion of women contacting a midwifery team who were given the help that they needed during antenatal care dropped from 74% in 2017 to 69% in 2022. As for postnatal care, only 70% of mothers were “always” given the help that they needed when contacting a midwifery or health visiting team, a fall of nearly 10% since 2019. The downward trends continue: less than half—just 45%—said that they could “always” get support or advice about feeding their babies during evenings, nights or weekends, down from 56% in 2017, and just 59% said they were always given the information and explanations that they needed during their care in hospital, down from 66% in 2017.

What those statistics show is that mothers do not have full confidence in our system, and things are only getting worse. It is therefore not surprising to hear that, according to the Birth Trauma Association, between about 4% and 5% of women who give birth develop a post-traumatic stress disorder: that is about 30,000 women a year in the UK. The symptoms include flashbacks, nightmares, and extreme anxiety that make daily life immensely challenging. This is a shocking and sad indictment of the current system and shows how much more needs to be done.

We should also not forget the vast health inequalities that exist across Britain. We should all be aware of the fact that women in the nation’s most deprived areas are 3.5 times more likely to die from an avoidable cause than those in the least deprived areas, and the fact—mentioned by my hon. Friend the Member for Canterbury —that maternal mortality among black women is currently almost four times higher than it is among white women. That is why Labour’s mission sets an explicit target to end the black maternal mortality gap. The pandemic, of course, exacerbated those existing inequalities, particularly among the most vulnerable women in our society. As we heard from the hon. Member for Stafford and my hon. Friend the Member for Canterbury, the feelings of anxiety, helplessness, and fear that those with birth trauma endure are traumatic for all, but for women also to know that they are more at risk because of their race, their income or where they live is shocking, sad and wrong.

Yesterday, along with the shadow Secretary of State for Health and Social Care, my hon. Friend the Member for Ilford North (Wes Streeting), I met representatives of the Maternal Mental Health Alliance. They welcome the roll-out of maternal mental health services in some parts of the country, focusing on those with mental health difficulties arising from trauma or loss related to childbirth, fear of childbirth, miscarriage, stillbirth, neonatal death, pregnancy termination and loss of custody whose needs are not currently met by other services. What concerns them is that these services are not available in every part of England. As the hon. Member for Stafford pointed out, there is significant variation in the support offered by the services that been rolled out so far, creating a postcode lottery for women, babies and families. The alliance is also concerned about the lack of sustainable funding for many services. These are fundamental services providing vital care for women; they are not luxury extras. We need to ensure that in all parts of the country, women who have experienced birth trauma and are struggling with their mental health have access to specialist support, and that there is continued funding in every area to meet the level of need that we know is out there. That is the alliance’s ask of the Minister.

I want to make it clear that I am not saying we do not appreciate the vast majority of our NHS and healthcare workers. Labour believes that the NHS is the backbone of our country, and will never abandon the founding principles of the NHS as a publicly funded public service, free at the point of use. However, as with so many other issues, this Government are presiding over a healthcare system that is going backwards rather than forward. It is the Government’s role to break down barriers and solve the difficult problems that we face, but it sometimes seems that those barriers are becoming higher and higher.

I want to raise with the Minister some concerns about the women’s health strategy. It lacks a plan to tackle the increasing waiting lists and a plan to enhance maternity care standards, and it fails to address the persistent staffing shortages. As my hon. Friend the Member for Enfield North (Feryal Clark) has said previously, it is plainly inadequate. The Royal College of Midwives told me this week that fundamental to delivering better maternity care is having enough midwives. The fact is that midwives are leaving the profession in droves, and the Government are failing to stop it happening. The Minister must tell us how she plans to keep the staff whom we currently have and ensure that the problems do not continue to worsen.

On top of those shortcomings, there is the problem that when a mother needs mental health support, the resources simply are not there. Midwives do not have the expertise or the time, and the result is that parents’ mental health is not being fully assessed. Overall, patients seeking mental health treatment spent more than 5.4 million hours waiting in A&E in 2021 and 2022. The reality is that patients are waiting or being overlooked rather than getting the support that they need. It is therefore no surprise that the deputy chief executive of NHS Providers has said that mental health services are over- stretched and understaffed, and that trusts are deeply concerned about the levels of unmet need. We need measures to address all these problems early.

Let me end by again congratulating the hon. Member for Stafford on securing the debate. I know it is not easy for her to share her story, and I hope she feels reassured that she has taken a significant step today in raising such an important issue.

13:07

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I, too, congratulate my hon. Friend the Member for Stafford (Theo Clarke) on her courageous speech, in which she described the birth of her daughter and the terrifying experience that she had. It is good to hear that she received such great support from her NHS team, but concerning to hear of her negative experiences—and as a former Minister for maternity services, I know that they were not isolated and that many others will have had similar experiences. My hon. Friend is a tireless advocate for women who have suffered birth trauma, and I pay tribute to her for the work that she has done and, I am sure, will continue to do.

I also congratulate Members on both sides of the House who have shared their personal experiences and those of their constituents, including my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who does so much in the area of baby loss, and who I am sure will speak in the next debate. The hon. Member for North Shropshire (Helen Morgan) talked about her experience of a caesarean section, and I want to reassure her that we are trying to move away from terms such as “normal” and “natural” to the term “a safe birth”, whether that refers to a “natural” birth or a C-section. I have been working with the hon. Member for Canterbury (Rosie Duffield) on the East Kent inquiry and its recommendations, and have met many of her constituents who also shared their traumatic experiences about the care they had received.

I thank my hon. Friend the Member for Moray (Douglas Ross) for sharing his experience as a partner, and also for pointing out that many of these issues apply to all four nations of the United Kingdom. I respond as the Minister for services in England but, obviously, I work closely with devolved colleagues to try to ensure a consistent service across the country.

I have listened very carefully to the contributions and pay tribute to everyone for their courage in sharing their stories. Before this debate, I was pleased to meet my hon. Friend the Member for Stafford to talk about the issues she has raised and to share with her the many pieces of work that the Government are already starting, after they were shared by women across the call for evidence on the women’s health strategy and by meeting many women across the country to discuss maternity services. We clearly need to do much more in this space, but I will also share some of the progress we are making.

I salute the work of the newly established all-party parliamentary group on birth trauma, chaired by my hon. Friend, which is showcasing an issue that very few people like to talk about. She discussed breaking the taboo, because even women who have been through birth trauma are often very reluctant to talk about this difficult subject, but the issue affects thousands of women. We can see from the response in the Gallery how important it is that we break the taboo and talk about these issues, both to prevent birth trauma and to manage the consequences when it happens.

I commend the work of charities such as the Birth Trauma Association and the many campaigners who are here today. It is important that we highlight this issue, because many women going through pregnancy do not realise some of the choices that are available to try to prevent birth trauma in the first place.

Birth trauma and injury take a toll on women, both physically and mentally, and greater awareness from the public and healthcare professionals is crucial to preventing birth trauma and mitigating its impact on women’s lives. We have heard a number of examples of compassionate care, which is essential both in reducing and preventing injury and in helping women and their families to cope with the impact of injury when it happens.

[Hannah Bardell (Livingston) (SNP)]

I am sorry that I was not able to be here for the speeches, but will the Minister join me in commending health practitioners such as Stephanie Milne, who runs Physio Village in my Livingston constituency? She does mummy MOTs, and she talks a lot about birth trauma and how her work supports women who have been through birth trauma. Does the Minister agree that the NHS can do more to help women through such post-natal healthcare support?

[Maria Caulfield]

I absolutely pay tribute to them. We have heard some great examples of work happening around the country, but the point has also been made that it is not consistently available to everyone. Those examples show why compassionate care is a key part of the work we are taking forward, particularly in relation to Bill Kirkup’s report on maternity and neonatal services in east Kent, which was published last year. Dr Kirkup rightly emphasised the need for compassionate care and a change in culture as well as a change in practice for women throughout their pregnancy, labour and post-natal period.

Compassion, kindness and understanding all require women and their families to be treated as individuals and to be heard. That is something we heard strongly in our call for evidence on the women’s health strategy, to which we had over 100,000 responses. That is why birth trauma is mentioned in the strategy, and I will talk about that further.

As part of this, we have to recognise that the PTSD, psychological trauma or depression that a mother may experience also have to be supported. Just delivering a safe birth is not enough. Wearing my other hat as the mental health Minister, it is why new mums are a high-risk group in the suicide prevention strategy. It is a shocking statistic that the leading cause of death in new mums is suicide, but it is a very vulnerable time in a woman’s life. They are often isolated from work colleagues if they are on maternity leave and, if they are a first-time mum, they will not have a support network of other mums. We hear all over the place on social media what a wonderful time it should be in a mother’s life, that they should be blooming with a new child, but the reality can be very different. We have heard that today, whether it is issues around breastfeeding, not sleeping or just feeling isolated. On top of that, birth trauma can cause difficulties in not being able to drive and with being in pain—there is a whole raft of issues.

Through the work we are doing on maternity and focusing on new mums as a high-risk priority group in mental health, we are trying to drive forward changes to support women better.

I am pleased to have the opportunity to update the House on the wider progress we are making to improve outcomes in pregnancy. I fully understand the importance of preventing perineal trauma during childbirth. We have to be honest that we cannot always prevent it. I am not a midwife, but there are risk factors such as a larger baby, a smaller cervix or a long birth that mean trauma and injury will sometimes happen. There is no doubt that we need to do more to reduce the incidence of perineal trauma but, if it happens, we need to manage it in a much better way.

That is why I am pleased that NHS England has this week published a national service specification for perinatal pelvic health services, which it aims to roll out across England by March 2024 in order to end the postcode lottery of services. The specification states that the services will work with maternity units across England to implement the obstetric anal sphincter injury care bundle developed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.

As my hon. Friend the Member for Stafford said, getting the specification rolled out across the country is an early success for the APPG. I am confident that this new guidance, which will be implemented across maternity units, will reduce the rate of anal sphincter injuries resulting from labour and vaginal births and help to manage such injuries in a much better way when they happen.

The introduction of these services will broaden the core service offer of pelvic health beyond the existing NICE and RCOG guidelines on care for obstetric anal sphincter injuries. The services will make sure that all pregnant women get the advice and support they need to prevent and identify pelvic health problems, and that those who do have problems are offered conservative treatment options before surgery is considered, in line with NICE guidelines.

We all know the crucial role that midwives play in recognising women who are suffering perinatal mental illness, including by taking a trauma-informed approach to care. To support this, NHS England is refreshing its core competency framework for perinatal mental health. The shadow Minister touched on this, and I reassure her that, by the early part of next year, every integrated care system in England—I cannot comment on what is happening in Labour-run Wales—will have a fully working maternal mental health service to support mothers experiencing moderate, severe or complex mental health difficulties.

It is true that the number of women accessing perinatal mental health services has risen by almost 50% over two years, but that is good news because we want women to come forward. The challenge for the Government in England is being able to meet that demand. For too long, women have suffered in silence and isolation. When they come forward, we need to have the services to support them. This demonstrates that mental health services are more important than ever before.

A number of colleagues have identified the issue of inequalities in maternity care, and we know that some women, particularly Asian, black and working-class women, are experiencing poorer mental health and poorer outcomes in maternity across the board. That is why we continue to fight to introduce NHS equity and equality action plans across the country. I am proud of the progress we are making on developing resources, and I pay particular tribute to the maternity disparities taskforce, which is working with organisations to deliver this as quickly as possible.

A number of issues were raised in the debate and, touching on birth trauma in the women’s health strategy, we will fairly soon be updating our year 2 strategy and setting out our priorities. I will let Members know about that as soon as possible.

There is a lot we could talk about in this space, and I pay tribute once again to my hon. Friend the Member for Stafford and all colleagues who have shared their experience. I reiterate that this is a priority for the Government. We are seeing change, but more change needs to happen.

13:09

[Theo Clarke]

First, let me thank the Minister for listening to the calls of mothers across the UK and for taking action. It is fantastic news that NHS England will now be implementing the OASI care bundle to ensure that we reduce birth injuries across England. I also thank her for working so constructively with me ahead of this debate. I am delighted to hear that there will be a refreshed update of the women’s health strategy, which I very much hope will include birth trauma.

Secondly, let me thank all the hon. Members who have spoken in the debate. In particular, I thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who has done amazing work on baby loss and chairs the all-party parliamentary group on baby loss. I thank my fantastic APPG co-chair, the hon. Member for Canterbury (Rosie Duffield), for sharing the personal experiences of her constituents. I was also struck by the contribution from my hon. Friend the Member for Moray (Douglas Ross), who talked about the experience of dads, which we do not talk about enough in these debates; by the interventions from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), my hon. Friend the Member for Wolverhampton North East (Jane Stevenson) and my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom); and by the contributions from many others. It has been a critical moment in history for us to hold today’s debate, and I hope that the women watching, both live on television and here today, feel that they have been listened to and heard. We have heard from the Minister that action has been taken today on birth trauma.

Question put and agreed to.

Resolved,

That this House notes that many women across the UK experience birth trauma; and calls on the Government to take steps to support women experiencing birth trauma.