Baby Loss and Safe Staffing in Maternity Care

Jill Mortimer Excerpts

Tuesday 25th October 2022 Westminster Hall

[Jill Mortimer (Hartlepool) (Con)]

I beg to move,

That this House has considered baby loss and safe staffing in maternity care.

I am honoured to begin this important Baby Loss Awareness Week debate about safe staffing in maternity care, which is imperative. I speak today as the co-chair of the all-party parliamentary group on maternity, but also as the mother of three children. I also speak today because of my three very different pregnancy and birthing experiences, which for me highlight the impact of different staffing approaches on pregnant women.

I lost my first baby in the very early weeks of pregnancy, and I was told by a very kindly midwife that sometimes you have to lose a baby to ripen the womb. This made me feel dreadful. I fought very hard not to grieve openly for that loss, because I felt guilty that I should not. Forgive me: I am full of cold and dosed up, so I will get very emotional.

My first experience of birth 30 years ago was, as it is for many first-time mothers, a long and painful labour. I was persuaded to have an epidural; I think the words were, “You need Slick; he’s very good. Call for Slick.” When it is your first baby, you do not know how labour should feel. You think, “It’s worse for me than everybody else, because I am in so much pain.” So I took the epidural. I was then left for long periods without being checked. There were not many staff on the labour ward that night, and I was in a room on my own with my husband. I was told that when I got nearer they would remove the epidural, because I would need to push.

Sadly, but thankfully, it was only when, unbeknown to me, my son was crowning and in distress that the midwife happened to look in for a check. I had to have an emergency episiotomy and an emergency forceps delivery, which resulted in me having a really severe post-partum haemorrhage, and I nearly died. I remember looking at my new baby in the arms of his father and thinking, “They’re safe; I can go now,” and then I blacked out.

My second son was an extremely large baby, at almost 11 lb, but this was not picked up and he basically got stuck—

[David Rutley (Macclesfield) (Con)]

A whopper.

[Jill Mortimer]

He was a whopper; he still is a whopper. It caused long-term damage to my pelvis but, worse, he has had to battle his entire life with learning difficulties caused by a lack of oxygen at his birth. He was a floppy, quiet baby, and at 18 months he was diagnosed with, among other things, hypertonia. All his development was delayed, and he did not walk or speak until he was nearly two. I worked with him, and I am so proud that he kept battling on learning how to learn. Today, at 27 years old, he is training to be a nurse. [Hon. Members: “Hear, hear!”]

It was only during my third pregnancy that I experienced continuity of care, which was wonderful. The ability to build a relationship with my midwife, who stayed with me throughout my pregnancy, labour and beyond, was invaluable. I did not have to go through my story with new people all the time and had someone I came to know and trust by my side. I was lucky enough to experience that and wish more women had that chance.

Despite the benefits of continuity of care, I look back on the pregnancy and birth of my daughter with mixed emotions, because there should have been two of them. Very early in that pregnancy I again started to bleed. I bled with my first son and ended up spending a week in hospital, with people saying to me, “Don’t worry, it’s very early on; you’ll have another baby.” I lay still for a week, I did not breathe, and I kept him. But this time I started to bleed again, and I miscarried my daughter’s twin. I did not know how to feel or how to grieve, while having to put all my efforts into sustaining my pregnancy, fearful every day that I would lose the baby I still carried. I was lucky that my beautiful daughter was born safe and healthy, but that loss never goes away. With each milestone, I reflect on how they should be celebrating together. There should be two of them.

[Guy Opperman (Hexham) (Con)]

Grab a breath for a second. First, I congratulate my hon. Friend on bringing forward this vital debate. The House is joined with her in supporting the cause that she is espousing. Does she agree with me—this is something that I certainly have suffered from—that the concept of the take-home child is something we all need to come to terms with? I have had three children, but I have been able to take only one home. For my hon. Friend, it is unquestionably the case that she loves and adores her daughter, but never forgets those who came along with her but did not make it in the end. Is that a fair description of the situation?

[Jill Mortimer]

It is, Guy. Now you have made me feel more upset.

[Guy Opperman]

I was trying to help!

[Jill Mortimer]

You have done. Yes, that loss never goes away. I still feel guilty, because it was so early; I did not go through what people such as my hon. Friend have gone through.

[Kim Leadbeater (Batley and Spen) (Lab)]

I thank the hon. Lady for sharing her deeply personal and emotional story. I want to place on the record my thanks to Alex Walmsley in my constituency, who recently won a BBC Radio Leeds “Make a Difference” award for founding Sands United West Yorkshire, a football team that provides peer support for men affected by baby loss. We often tend to focus on the women, but it is really important that we talk about the fathers who have suffered that loss as well. Does the hon. Lady agree that keeping open local maternity units, such as the Brontë birth centre in my constituency at Dewsbury and District Hospital, is essential to maintaining safe and quick access to maternity services for our communities?

--- Later in debate ---

[Jill Mortimer]

I agree that local maternity services— I have the Rowan suite in Hartlepool—are invaluable, because the midwives know their community. They know the women—they are often friends with the mother or an aunt—and that gives them the feeling that people are listening all the time. It is also important that we get midwives trained in bereavement care. I wonder how that kind of care and intervention may have impacted my experience and helped me to cope with emotions of guilt and loss while still allowing myself to feel joy for the life that I had brought into the world in my daughter.

Sadly, experiences 25 years on from mine have not got any better. I am proud to be here today to speak on behalf of my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory)—my friend and colleague—who, as co-chair of the all-party parliamentary group on baby loss, has told us all of her own recent terrible experience of baby loss. We have just had the publication of the Kent report, which details 200 incidents at hospitals in Margate and Ashford. Baby loss still happens all too often. We simply need more midwives so that they can feel confident that they are providing the very best care they can to all mothers. As noted in the Ockenden report, it is not just about safer staffing levels: it is about quality care. We need more trained bereavement specialist midwives.

[Sir Roger Gale (North Thanet) (Con)]

I had not intended to intervene, because I have to leave the debate, but my hon. Friend mentioned the Queen Elizabeth The Queen Mother Hospital; as the constituency MP, may I place on the record my concern, and the fact that we are pursuing with vigour—and I mean with vigour—every angle to ensure that what happened there never happens again?

[Jill Mortimer]

I thank my right hon. Friend for his intervention. I am reassured that everybody involved in that case is working hard to put things right.

I am regularly in contact with the wonderful staff at the Rowan suite in Hartlepool. They, too, advocate for the importance of bereavement care for grieving parents. The reality is that bereavement specialists have on average just two hours of working time to dedicate to each baby death. That is simply not enough. I have heard from bereavement midwives who are left having to choose which parents they go to. There are simply not enough of those midwives to go round. Parents who were so full of hope hours earlier are left alone, suffering the rollercoaster of grief that fills the inevitable void from losing a pregnancy or a baby. Expert, kind and understanding support is vital at that terrible time.

I have also met representatives of Sands, one of the many great charities that work in this important area. They have told me that cases of stillbirth in England and Wales rose in 2021 for the first time in seven years. That reflects the experiences of mothers who contacted Mumsnet to say that during covid most of their maternity appointments were cancelled. Mumsnet contacted me to share those mothers’ stories. One mother said that her previous history and notes were ignored and that a previous condition she had suffered from escalated and caused unnecessary complications. She felt that was due to bad organisation, shortages, funding cuts and bad management during covid, which left the delivery unit at her local hospital dangerously understaffed on the night her daughter was born.

I have three asks of my hon. Friend the Minister. Covid is largely behind us, but maternity staff are still exhausted from that time, and 13 babies are stillborn or die shortly after birth every day. Will the Minister please tell us what steps the Government are taking to ensure the 2025 ambition announced by the Health Secretary in 2017 to halve stillbirth and neonatal death rates?

The joint meetings of the APPGs on maternity and baby loss have listened to evidence and stories from multiple women and agencies, and we have commissioned a report with Sands and the Royal College of Midwives. We want to ask the Minister whether she will commit to increasing investment in maternity services and fulfilling the shortfall of 2,000 midwives and 500 consultant gynaecologists and obstetricians. We need more and, sadly, it is becoming harder to retain staff because they are burnt out from the effects of staffing shortages. It is a vicious cycle.

[David Linden (Glasgow East) (SNP)]

I pay tribute to the way in which the hon. Lady has opened and framed this debate. I speak as chair of the all-party parliamentary group on premature and sick babies and I absolutely agree with the points she is making. Will she go slightly further and ask the Government to consider amending the shortage occupation list so that we can attract more people to come here and fill those roles? We all know a massive timebomb is coming down the line in terms of the neonatal workforce and those on maternity wards.

[Jill Mortimer]

I thank the hon. Gentleman for his intervention. Sadly, that is not a matter for me as I am not a Minister; it will be for the Minister to reply to that.

Will the Minister look at training more bereavement midwives? Sands has developed the national bereavement care pathway, which provides the framework and tools to ensure that all health professionals are adequately equipped to provide the standard of bereavement care so sorely needed during the immediate aftermath of pregnancy or baby loss. That would prevent women like me, 30 years on, from hearing those same lines; health professionals would understand that, kind as they are meant, they do not help in the long term.

[Alicia Kearns (Rutland and Melton) (Con)]

I thank my very good friend for her work on this issue. On the point about discrepancy, in my constituency a baby died—it was negligence—and the mother was sent home with four leaflets and never contacted again by the hospital. By contrast, my very best friend lost her baby at nine months in January—as Members can see, we all grieve when we lose someone that close to us—and she had phenomenal care from Tommy’s. Will my hon. Friend press the Minister to do all she can to ensure that there are national guidelines against which the NHS is held to account, monitored and graded for how it provides bereavement care?

[Jill Mortimer]

I thank my hon. Friend; she must not apologise because obviously this issue is very close to us all. We feel very deeply for all mothers who lose. That is one thing that I wish to ask the Minister to do: will she ask the Government to mandate the national bereavement care pathway so that it is nationwide? Although 105 trusts are already formally committed to rolling it out, they need the additional funding to fully implement all the standards of the NBCP. It is no good just taking part of it; we need it all in place and all midwives need to have that training. What steps is the Minister taking to ensure that all trusts can implement this vital support service?

Those are the three big asks. I know they are big, that times are not great and that there are not funds, but this is such a vital policy area and so much long-term pain could be caused. I thank Members for their time.

[Several hon. Members rose—]

--- Later in debate ---

[Jill Mortimer]

I sincerely thank all colleagues who have taken part in the debate, particularly those who have shared their own devastating personal stories. As the hon. Member for Leeds East (Richard Burgon) said, there is clearly cross-party support for addressing this important issue; I do not think anyone in the Chamber wants to quote from any more reports. Will the Minister kindly take what she has heard today to the Prime Minister and ask that it be made a priority?

Question put and agreed to.

Resolved,

That this House has considered baby loss and safe staffing in maternity care.