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It’s hard to imagine anything worse.
Expectations dashed. Hopes gone. Dreams turned to nightmares.
The loss of a child and everything it entails is beyond description. If it is possible to imagine anything worse, it has to be knowing the loss could have been avoided.
About four babies per thousand are lost during or shortly after childbirth. While perinatal mortality has improved since 2010, progress has stalled, and England hasn't met its goal of halving 2010 rates by 2025.
For over thirty years we’ve known something’s wrong with birthing our babies.
In 1992, the first of the Winterton Reports, on maternity services.
In 1993 the first review from Baroness Cumberlege, a, then, junior health minister… called ‘Changing Childbirth’.
In 2008, Niall Dickson, the former head of the King’s Fund think-tank, commissioned Cumberlege again, for the ‘Safe Births’ review.
Then;
- 2015… Kirkup Review
- 2016–2022… Ockenden Review
- 2018… HSBI investigations into term still-births, neonatal deaths and severe brain injuries at birth… 702 reports and 1,380 safety recommendations
- 2019–2022… another Kirkup Review
- 2022 and ongoing… Nottingham Hospitals, Ockenden again
- 2023… Maternity and Neonatal Delivery Plan; NHS England
- 2024… CQC, Thematic Review of Maternity Safety
… that’s ten serious, in depth reviews of failing maternity services.
Our Great Leader has decided there’ll be an eleventh; a National Maternity and Neonatal Review, which will review-the-reviews and a task-force that will focus on national system failings and improvement.
My guess is number eleven will land on pretty much the same seven topics of failure that were the upshot of the previous ten;
1. Poor Culture, Leadership & Psychological Safety
2. Staffing Shortages & Inadequate Training.
3. Poor Teamwork & Inter-Professional Coordination
4. Weak Incident Reporting & Learning Systems
5. Poor Communication & Lack of Compassion
6. Continuity of Care and Informed Choice
7. Data Gaps & Inequity
Leaders of these services and the Royal Colleges already know what they need to know… what eludes them and us;
- Proactive safety culture, with open incident reporting
- Strong continuity of midwifery care, including home visits
- Highly trained, well-supported workforce
- Data-driven equity strategies, ensuring all demographic groups receive optimal care
… and if the professions can’t sort safer births from all this, then there is something wrong... because they haven't.
And, there is.
Something wrong. Very wrong. Strange.
Something I can’t explain. Weird, even.
Everyone will tell you, one of the safest places to give birth is Finland.
What do you make of this…
Using Nuffield’s reference costs, in England the cost per birth is an average of £3,000 - £5,000. Complicated births (emergency C-section, neonatal care) might run up to £15k.
In Finland, using Finnish Institute for Health and Welfare numbers, cost per birth is ~£2,100 - £3,400. Complicated, up to £8,500.
Finland is Safer and cheaper.
Yes, I know. England; maybe higher labour and infrastructure costs, and may use more expensive interventions earlier?
But…
… we also know Finland benefits from a more streamlined, midwife-led model of maternity care, with lower rates of intervention. The outcomes… maternal and infant mortality, satisfaction, breastfeeding rates… are generally better in Finland…
… all of that… despite the lower cost.
There are other factors. Poor maternal health significantly contributes to England’s maternity outcomes; obesity, age, deprivation, and inequalities.
But, it’s not a sufficient explanation.
If we take the evidence of the past, we might say Streeting’s intervention is a cruel deception and will give bereaved families false hope… this will be another report, on the shelf, with the others.
Political grandstanding from an ambitious man, who we know enjoys the spotlight.
On the other hand, this initiative bears his name. He is to chair the national committee and must report by the end of the year.
We know what the report will say; maternity services are ‘broken’ and there are the usual seven failings. But…
… what we don’t know is the appetite for creating maternity services from scratch. Just how much of the past will be swept away…
… the CQC, RCOG, RCM, RCEM, NHSE, HSIB/MNSI, LMNS, ICBs and the NMC/GMC… with overlapping remits, variable implementation and accountability gaps…
… cost millions and births are still not safe enough.
Finland has their institute for health and a national supervisory authority and safer, cheaper services…
… all you need to know.
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