Time to listen.

IN days before the current sophisticated technology, training and drugs associated with childbirth, it was accepted that the short journey from womb to daylight was the most dangerous of our lives, not just for the child but for the mother too.

Now in the modern technological world of scans, Caesarian sections, monitors, forceps and epidurals, we believe that we have greatly reduced the risks: the oldest medical procedure need no longer be the most dangerous.

All of which makes the findings of the inquiry into the Morecambe Bay baby deaths so disturbing. According to the report, a “lethal mix” of failings at virtually every level within the Trust led to the unnecessary deaths of one mother and 11 babies in the maternity unit at Furness General Hospital.

Maternity services, the inquiry report says, were beset by a culture of denial, collusion and incompetence. Midwives, who were determined to pursue normal childbirth “at any cost”, were so cavalier they were nicknamed “The Musketeers”.

As a clinical negligence lawyer, I regularly deal with cases where births have gone wrong, often tragically so, but the Morecambe Bay saga is a monument to collective incompetence and obfuscation which should not exist in any 21^st century health service.

In the Morecambe Bay case one must ask  whose agenda “The Musketeers” were following. Midwives are not pressured to promote natural childbirth to save money. Hospitals receive more Government funding for each Caesarian-section perf

But the Morecambe Bay cases are not isolated. During a decade the NHS has paid out £3.1bn to babies and mothers injured as a result of staff errors during childbirth.

A 2012 report from the NHS Litigation Authority detailed the mistakes which occurred in 5,087 births in England between 2000 and 2010 and highlighted junior doctors and inexperienced midwives managing women’s labour without enough help from senior clinicians.

I am sure, as described in some press coverage after the inquiry report, that in some hospitals there is a turf war between midwives and obstetricians and that this can create a clinical environment where teamwork is marginalised.

However, I suspect the more common problem is down to staffing levels and lack of training. A midwife friend of mine recently left the profession after being asked to work 12-hour  shifts, seven days a week. She was too exhausted to provide a safe delivery to new mums.

My experience in dealing with claims also suggests that there are gaps in service provision, often limited obstetric cover outside normal working hours and at weekends. This means that a complex delivery, late on a Friday night, may not get the same quality of care that a Monday lunchtime delivery may.

Whether the presence of an obstetrician can guarantee a safe delivery is open to question. An obstetrician may have completed six years’ medical training but this will not all have been related to managing births. Sometimes, an available obstetrician will have delivered far fewer babies than an experienced midwife.

I have acted in cases where birth complications have happened following and occasionally, because of the obstetric involvement, rather than in spite of it. Obstetricians are often involved when a delivery has become difficult. They routinely perform forceps-assisted deliveries and caesarean sections and these interventions are not risk-free in themselves.

The Furness General Hospital inquiry report makes the point that there was a “subtle incentive” for staff to record a baby deaths as a stillbirth “when there is some doubt about whether there were signs of independent life” as coroners have no jurisdiction to investigate. The UK already has an unacceptably high level of stillbirths. That such a tragic outcome could be used as an administrative tool to save time and questions defies belief.

There is a lesson here for the NHS. If mothers to be, who are closest to what they feel is happening, were listened to and, at the time of delivery, were better informed and able to share decisions about their care and treatment, this would be a significant improvement.

It is tragic that – 46 years after we landed men on the moon – childbirth in one of the world’s richest nations is still more risky than it should be. Some complications and tragic outcomes are sadly inevitable but creating a reassuring, informed and inclusive process, which must be paramount to ensuring a safe delivery for mum and baby, must always be the goal.   

This is not always a budgetary issue, or necessarily one which needs high-level expertise: it is a matter of listening to, and caring for patients.