We have written here many times about Broken Britain: how many of our public services are in a state of severe crisis, showing the adverse consequences on people’s lives. Here I want to focus on a local problem – in Stroud – where the maternity unit is currently closed for in-house post-natal care and midwives and mothers are put under unacceptable pressure. The issue typifies a national problem, with many communities forced to advocate for, and march in support of their local maternity services which are under threat.
Maternity matters
The March with Midwives grassroots movement recently took to the streets across the country to support midwives and highlight the problems in maternity care. I spoke to Kate Buckingham, chair of advocacy group Stroud Maternity Matters and a local GP, Dr Simon Opher, about the group and their campaign.
The blessing of a new life coming into the world should be a joyous occasion for women, their families, and communities. A time of hope and celebration where we look forward to new beginnings, new dreams, and better futures. Naturally it is both a time of excited anticipation and one of anxiety. Women have relied on the support of wise and experienced midwives since time immemorial to assist them in labour and in the post-natal period when care, advice and help are so vital, to develop parenting skills, build confidence and allay anxieties.
Yet in Stroud, as in so many places, a new mother is sent home just six hours after delivery unless there are serious clinical reasons, when women are transferred out of the local area to Gloucester Royal Hospital, since there is now no other provision in the county. It must be frightening for women to feel they are on their own unless they have good family support and sufficient access to a Community Midwife, Health Visitor and to their GP practice.
Of course, these are currently in short supply in the overstretched NHS. We know that good care in pregnancy, labour and the post-natal period are vital to the mental and physical wellbeing of mothers and their babies.
Recent evidence of rising maternal mortality
In the context of the reduction of maternity services, two recent studies have found disturbing evidence of rising maternal death rates in the UK. These figures are an important indicator of the quality of the care provided and the performance of health systems.
A major review by MBRRACE-UK has called for better post-natal support as an urgent necessity. It found that maternal mortality rates have risen significantly in the UK. Women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy in 2020 compared to the 2017–2019 report. Maternal suicide was also a leading cause of death in women between six weeks and a year of their pregnancies ending, accounting for 18% of the women who died between 2018 and 2020.
Another study published in the British Medical Journal, found that the UK has the second highest maternal death rate in an eight-country European comparison.
This is a tragic indication of a lack of government commitment and investment in maternity services, according to the Royal College of Midwives (RCM). Many women who died often had multiple disadvantages, including health and social problems. It is critical that sufficient resources are available to enable appropriate care across all services to recognise and respond to the individual needs of all women during and after their pregnancies, in effect, to save lives.
A chronic shortage of midwives is not sustainable
The chief cause of this unsatisfactory running down of services is a longstanding chronic shortage of midwives which inevitably has an adverse impact on the safety and quality of maternity care. Many Care Quality Commission (CQC) reports on individual trusts say poor staffing levels are having a serious effect on care. The RCM say that England remains 2,000 midwives short of the numbers needed and month by month the number in practice is falling. Both recruitment and retention of midwives is problematic, not helped by the decision to charge nurses for their training since 2012.
It is not just an issue of midwives wanting better pay, although this has decreased in real terms. They also have concerns about working conditions and the safety of mothers and babies in their care. Trusts expecting fewer NHS staff to work more intensively, in more stressful working environments is not a sustainable position. There are currently 22 vacancies for midwives in Gloucestershire Hospitals Trust. They have recently had a poor CQC inspection and the lack of midwives causes them to withdraw staff from what the Trust deems are peripheral units such as Stroud.
Midwives are so exhausted and disillusioned that they are deciding to leave the profession they love in large numbers. The RCM has just launched its second ever ballot on industrial action in England and its first in Wales in its 142 year history, joining other key professionals in the NHS who are deciding to go on strike.
Stroud Maternity Matters
The group was set up in 2006 by midwives who wanted local service users, women who had had their babies in the very precious Stroud Maternity Unit, to advocate for them, to give voice to local people’s wishes and to lobby for the Unit to be kept open in the face of continual NHS cutbacks. Click here to link to the Stroud Maternity Matters Facebook page.
The post-natal facility is much loved by local people. It offers more time to recover from birth, to establish breast feeding, and is a safe space to be gently monitored by professionals. This makes an enormous difference to rates of post-natal depression in the town and creates a sound foundation for parenting.
Stroud has a distinctive culture of what people want for their families, starting at birth and in the first days of a new baby’s life. Birth in UK has become a highly medicalised and standardised environment but this is not always what people want and many question whether this is the way we should be going as a country. Empowering women is a key aspect of the care at Stroud Maternity Unit. Sadly, this sort of exemplary provision is quickly disappearing.
Closure of Stroud post-natal unit and fears for its future
Post-natal care at Stroud was closed more than 50 days ago. The Trust promised that this was a temporary measure and promised weekly reviews but as Kate notes, despite continual pressure by the group, the Trust has failed to update the situation amidst fears that it may never re-open: “we worry [removing] it represents a back-door closure of the unit,” she said. There is a petition to keep Stroud Maternity Unit fully operational.
Day of Action and Stroud March with Midwives
On Sunday 20 November, over 1,000 local people came out in Stroud to protest about the closure of the Unit and against a “staffing and safety crisis” as part of a National Day of Action by midwives, joining many others across the country.
Among the speakers were mothers, fathers, midwives, the current Conservative MP and several local politicians including Dr Simon Opher, a local GP and Labour Parliamentary Candidate for Stroud. He said
“We are wholly committed to Stroud Maternity Unit and the local midwifery team. It is essential that they continue to provide the best comprehensive support for local mums and their families. We must have sufficient funding for the NHS to pay people properly, a supportive infrastructure, and a culture of respect that truly values the profession, and that means political change.”
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