Birth Trauma

Theo Clarke Excerpts

Thursday 19th October 2023 Commons Chamber

[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.

--- Later in debate ---

[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.