Maternity Services

Baroness Thornton Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is a great pleasure to be taking part in this debate, and I thank my noble friend for her balanced introduction. I declare an interests as the maternity safeguarding non-executive member of the Whittington Hospital board and, of course, my day job as the shadow Women and Equalities Minister, both of which will inform my contribution today.

My life and possibly my son’s life might have been lost without maternity services when he was born 37 years ago at the Homerton University Hospital. I think he was the fifth baby born there—it was a brand new hospital—and the midwife and I were wandering around trying to work out where the light switches were. There is no doubt that they saved our lives; 100 years ago, we would both have died. We must recognise the great progress that has been made in antenatal and natal care in our NHS. I was particularly moved by the contribution of the noble Lord, Lord Patel, the importance of which is reflected in the Ockenden review and the need for multidisciplinary teams in our maternity units. We are talking about not just midwives but the role of people such as the noble Lord and our gynaecologists.

I meet amazing and dedicated midwives in the course of my work as a non-executive member of the Whittington Hospital board, and they are all too aware of the challenges they face, because there is a desperate need for more resources and better staffing. The Whittington is an old hospital. Some bits were built in Victorian times, including the entrance to our maternity unit, which might still have “lying-in” signposted on it. The noble Baroness, Lady Cumberlege, graciously opened a new birthing suite for us about a year ago and will bear testament to our having to adapt our facilities all the time.

One thing I am sure of is that a change in culture is still required in the NHS if it is to place the value on maternity services that it places on other medical services. I was conscious that maternity did not feature as often or as highly as it should have in our governance arrangements. It does now, but that is probably writ large in our hospitals right across England. As my noble friend Lady Taylor said, the core of the challenges outlined by the Ockenden and CQC reports is staffing. In its briefing, the Royal College of Midwives notes all the relevant points: 2,500 midwives are missing, we need to improve retention of experienced midwifery staff and increase the number of newly qualified midwives, and we need to place real value on our existing maternity services. There is no doubt that some maternity services have failed women and families. It is important that those lessons are learned and that we ensure that those mistakes do not happen again.

We must eliminate the stark, persistent, unacceptable disparities in the maternity death rates suffered by black women, Asian women and women from some of our most deprived areas, as eloquently described by the noble Baroness, Lady Gohir. I agree with her about the need for collecting data. Having been involved in equalities work for a very long time—some 40 years—I know that if you do not monitor and do not have the data, you cannot know where discrimination is taking place or show where deeply rooted discrimination is embedded in our systems. You have to collect that data. This Government have not always done that, and occasionally they have stopped funding. They need to collect that data.

The Commons report on black maternal health was vital to this debate. I raised this with the then Minister, and we had an exchange about the root causes of black and ethnic minority mothers dying at a starkly higher rate than white women. We both agreed that it was partly embedded racism in our maternity delivery services, and partly socioeconomic reasons and deprivation in some of those communities. That does not mean that we do not need to address this. A report by the Muslim Women Network said that black Muslim women, especially black African women, were most likely to receive poorer standards of care, followed by south Asian women, particularly Bangladeshi women. The Commons report noted that the themes included—as the noble Baroness, Lady Gohir, said—a gap in data and information collection on the needs, experiences and outcomes of minority ethnic women; women not being listened to; and women receiving care that was neglectful and lacked dignity and respect. Those are some of the challenges we need to address in tackling the difference in mortality rates in our maternity services.

We also need to recognise that we must take urgent action to tackle what is acknowledged as systemic racism in UK maternity services. It is always hard to say that when you have worked in public life on equalities for as long as I have, but the noble Baroness, Lady Gohir, absolutely illustrated it. I am shocked. I did not know that we were not collecting data on the claims and financial implications of maternal and infant death.

I turn to a more positive story concerning working with a general integrated hospital at a local level, like my noble friend Lady Taylor. We are both from Yorkshire, and Bradford and Huddersfield are the hospitals with which I am familiar at home. We know that it is important that those hospitals respond to the needs of the populations they serve. As an adopted Londoner and a non-exec at the Whittington Hospital, I can tell the House that we have tried to address these issues in various ways. I want to mention some of them because they are important. We are a local general hospital slap-bang in the middle of the inner city, serving mostly the very mixed population of Islington and Haringey. By the way, I am particularly proud of the fact that during Covid, all our births were attended. We did not stop fathers and relatives being present at the birth of babies in our hospital.

The specialist services that our midwives offer have to reflect the needs of our local population. I am impressed—and I hope this will be a generalist remark—that, for the varying conditions presented by pregnant women, whether epilepsy, diabetes, bipolar or sickle cell, we have midwives who are specialists in those areas. They need to be, because these conditions would have been barriers to giving birth in the past or would have made it a very dangerous procedure. In our part of London, we have a sickle cell unit in our hospital—it is a generalist unit of which we are very proud, and it has this very specialist unit—and, of course, it works right across into our maternity unit. That is very important, because we have mums coming in who have sickle cell, with all the problems that that presents.

As mentioned by the noble Baroness, Lady Watkins, for instance, combining midwifery with other expertise and experience, particularly mental health services, is very important. A woman who has a serious mental health condition and is having medication for that will need to be carefully monitored right through her pregnancy. Those specialities are very important indeed, to say nothing of the fact that mental health problems can sometimes assert themselves anyway as a result of a pregnancy.

The second thing I want to talk about is female genital mutilation. As a local hospital, in 2000, we had to respond to the fact that we had a growing number of pregnant women presenting who had suffered female genital mutilation. So the Whittington Hospital now has a female genital mutilation clinic, which used to be known as the African Well Woman Clinic. It was established in 2000 by a woman called Joy Clarke. Today, that clinic provides services on FGM: counselling, antenatal care, assessment, de-infibulation—reversal of FGM—and post-surgery and postnatal follow-up. It provides that service not only in Islington and Haringey but to the whole of London, and women from all over the country come to avail themselves of those important services. The midwife who leads it is called Huda Mohamed. She trained as a midwife at the hospital, joined the FGM service in 2012 and became our FGM lead in 2016. It is such a highly regarded service nationally, and she has played such a crucial role in providing a comprehensive and holistic approach to managing and raising awareness of FGM and the significantly positive outcomes and benefits for women who have undergone this procedure. She was given an MBE in the New Year Honours List, and we are very proud of that.