Maternity Services

Baroness Armstrong of Hill Top Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I enter this debate with some trepidation, having heard contributions such as the last from such a distinguished obstetrician, but I thank my noble friend Lady Taylor for introducing the debate.

I echo what the noble Lord, Lord Patel, said: what happens in maternity services should be seen as a bellwether for the rest of the NHS. The CQC reports on maternity services that Members have referred to are really quite shocking. We know that for women who are pregnant, this period forms their view of the confidence they can have in the services that they are relying on during pregnancy. There is more than one: it is not just a midwife, it is the GP, it is whoever they see in community services, it is all the other services that prop up their eventual delivery, and the post-delivery services, that are under the microscope here. During my period of chairing the Public Services Select Committee in this House, in virtually every inquiry, we came across women who felt that their relationship had almost been defined by this during their pregnancy: if it had been a poor experience, that introduced anxiety, concern and just a little trepidation about how they would make sure that their health and that of their family was looked after in future. I wanted to intervene in this debate to tease that out a little more.

I thank all the myriad organisations which have written to us about this debate, but also the Library. We are really privileged to have such high-quality research and attention paid to us. Too often, we take it for granted and forget to say thank you to the Library staff for doing that.

All the reports and briefings highlighted staffing and leadership, as the Public Services Committee did. For me, they underpin this whole thing. There is a crisis in staffing and in the skills mix there needs to be to ensure a happy and successful pregnancy for mother and baby, and there is certainly a crisis in leadership. Far too many of the good leaders have left, partly over Covid and partly because of additional pressures. The workforce plan on its own is not the answer. As the noble Lord, Lord Patel, said, you can have plan after plan and review after review, but without adequate implementation they will be just glorified bits of paper on the shelf.

I know well the chief executive of the Maternal Mental Health Alliance, because I worked with her in a charity that I chaired before she took up this role. I have heard from her over the past two to three years about the challenges in this area. I thank her team for their work and their briefing, from which I have benefited over many months rather than just for this debate. They are now working much more on the inequalities highlighted by most speakers today. In the Public Services Committee, we looked at what Covid revealed about our public services. It was absolutely clear that virtually none of them had understood the depth of the inequalities in how they responded to different racial and ethnic groups in our society.

We still have not got hold of what we need to do there. As the Minister knows, I have been anxious about this in terms of our preparation and trials of vaccines and how far they include ethnic minorities, because there are different genetic and cultural needs. Unless the workforce is sensitive and knowledgeable about that—practitioners must be enabled to be aware of it through their education and training, so that they can be sensitive to it when they are working with women from different cultural or ethnic backgrounds from their own—inequalities will be virtually inevitable. The Government have not been significantly sensitive to that in their approach, and that really concerns me.

Others have mentioned the stark reports from Embrace UK, which talk about not just the numbers but the effect on the women of their experiences. Others have talked about the numbers so I will keep my bit short, but, in looking at the care of black and white women whose babies have died, Embrace UK says:

“In around 1 in 2 baby deaths, the care assessed was poor. If care had been better it may have prevented the baby from dying … For around 3 in 5 mothers, care after their baby died was assessed as poor. If it had been better, it may have meant bereaved mothers were likely to have been better supported in their physical and emotional health”.


For both white women and black women—I will leave Asian mothers to the noble Baroness, Lady Gohir, as I am sure she will speak about them—the report assessed their care as good in only around one in five of the deaths reviewed. This is about basic care, not necessarily medical knowledge. Honestly, I am ashamed that we cannot do better and support our workforce so that it does better. Those disparities are huge.

On attitudes, another charity, Five X More, identified that the use of offensive and racially discriminatory language and being dismissive of their concerns was too often the experience of black, Asian and minority-ethnic women. Significantly, there was also a poor understanding of the anatomy and physiology of black women and of the clinical presentation of conditions in babies of black women. Then there were the racially based assumptions about the pain tolerance, education levels and relational status of black women. These are all issues in the basic care and attitudes experienced.

Most shockingly, mental ill health is the most common complication of pregnancy in the UK. At least one in five women experiences a mental health problem during pregnancy and after birth, and suicide is the leading cause of maternal death in the post-natal period. Again, this is honestly shocking. We need to be able to intervene much more appropriately. Midwives are ideally placed to ask sensitively about mental health in their routine contacts with women, but too often that simply does not happen.

Again, I come back to the fact that this is the time in women’s lives when they will have the most interactions with healthcare professionals, so it is the time to make sure that mental health becomes a normal way of working with women when they present to healthcare professionals—I do not see pregnancy as an illness—in whatever sense. Attention to mental health must be part of how they are handled.

I am really trying to say that there are lots of things that we know the Government must do. They need to get on and do them rather than continually doing reviews. Here I disagree with some other speakers; we need to get on and improve the services in the way that so many of us have been told they need improving.