Is the NHS failing women and babies?

0:02Sky News, the full story first.

0:08As NHS trusts across England are investigated over failures in maternity wards, Sky News hears firsthand how women are being let down, time and again. How does a banana trigger a CIA-backed coup? Do AirPods herald the arrival of a new global order? What do LED lights say about the future of humanity? I'm Ed Conway, and in each episode of my new podcast, Stuff Matters, I take an object, crack it open, and reveal the world-shaping forces hidden inside. This is economics told through the things we think we understand. Search Stuff Matters on your podcast app to listen and follow.

0:52Traumatic births are more common than anyone would wish. and a New Sky News documentary reveals that the effects of substandard maternity care can be felt long after any delivery. This is something that I haven't wanted to think about, let alone speak publicly about. This is a topic which is spoken about in whispered conversations. Something like this, like this birth injury, has affected my whole entire life.

1:23Professor Ranee Thakar:and you'd think that it wouldn't. It affects every aspect of it. And there's still no clear reason as to why and I think that not knowing is always going to haunt me. So why is maternity care seemingly so poor? Well, this week we may very well get some answers. The Maternity Review for England is to deliver its initial findings. Issues dating back 15 years at 14 separate trusts are being looked at. The inquiry's conclusions will shape midwifery for decades to come, but sadly too late for those in our report. So what should we expect? And why are so many women not receiving the safe, compassionate care they ultimately deserve?

2:07Leah Hazard is a practising NHS midwife. She's also a best-selling author, campaigner and mother of two. Leah, great to have you on the Sky News Daily. There is a popular perception that right now maternity services are not doing well across the country. Indeed, we've been hearing from the Royal College of Midwives that services are at breaking point. What's your view? I would absolutely agree with that. Services have actually been at breaking point for years. So I would actually say we're well past breaking point. The service is definitely broken. So it is possible to have a positive experience in NHS maternity, but it's getting more and more difficult.

2:44We've had years of chronic under-resourcing, underfunding, and it really shows. I mean, the system is absolutely broken. Let's just examine then a few of the ways in which mothers and indeed fathers have been complaining about the state of maternity care. And even before they get to the hospital, we hear from mothers whose choices when it comes to the birth plan are just not recognised, are not respected or entirely ignored. What is the danger in not listening to the mother at that stage of a pregnancy? Well, it's massively dangerous because as a midwife, we all should go in with the default view that women are to be believed and that their gut intuition and their preferences about their own body should absolutely be respected.

3:23So what should really be happening at every appointment, every encounter is a partnership where the woman is expressing her wishes and her concerns. And we're providing her with the up to date, accurate, good quality evidence to allow her to make the best, most informed, most empowered choice for her and her baby. So I absolutely understand that many parents are saying they're not being listened to and there is no excuse for that. There's no way we can rationalize or excuse that kind of behavior. So many women, indeed one of the women featuring in Sky's documentary, complain that when they are addressing the pain that they are feeling, they are either not being taken seriously or they're being completely ignored.

4:02Does that chime with your experience? It's certainly not the way I personally practice as a midwife, but the number of women saying that they have been treated like that is undeniable and again inexcusable. There's absolutely no reason to disbelieve or trivialize a woman's concerns, especially when she's in pain. And there's a lot of research now about birth trauma. And what we know what comes up time and again in the research is that it's not necessarily the mode of birth or the pain itself that causes trauma after the fact. It's the way that person was treated and spoken to while that experience was happening or while that pain was being experienced.

4:38So absolutely listening and being compassionate and responsive can make a huge difference to the woman's perception of the birth, both at the time and in retrospect. Why might that be the case, do you think, when it comes to pain relief? Because again, we also hear from mothers that during the process of birth, they are sometimes made to feel personally expendable, that they are nothing more than a birth canal, that they're often treated like a piece of meat. Well, as midwife, it makes me really incredibly sad to hear that. And I'm absolutely not here to be an apologist for that kind of behaviour.

5:09What you've just described is completely inexcusable and unacceptable in every possible circumstance. There can be no rationale or justification for treating somebody in that way. What we can get into a little bit more is why women aren't receiving the continuity they deserve, why they often don't have the correct number of staff giving them the time that they deserve. You know, that's a separate issue. But not being compassionate and treating somebody like they're just a body to be kind of dealt with is absolutely inexcusable. Does that just then speak to a lack of staff on a maternity ward? Is it something just as simple as that?

5:44Well, again, not listening to somebody cannot be excused. but we do often hear from women that they feel rushed, they never see the same midwife twice. Women coming in in distress or in labour often describe being left alone for periods of time or being aware that the midwife is caring for more than one woman at once. And that does chime with my experience. The midwifery workforce has been absolutely decimated over the last kind of 10-15 years, chronically under-resourced, chronically underfunded. We are dangerously overstretched. we are spread too thinly. Midwives know this and I think the service users are seeing this as well.

6:20So you could be the most compassionate midwife in the world and go to work and want to do an amazing job for the people in your care. But if, for example, your labour ward is supposed to have 12 midwives and it's become normalised for that labour ward to have six midwives, you can see where the difficulty lies in giving each person the time they deserve. I suppose that all women want during that particular process, well, aside, of course, from knowing that their child survives and is healthy and is being looked after. It's just that there is a form of care through that process that just allows them to get on with the job that a mother has to do in those circumstances.

6:55Yes, absolutely. Every person giving birth deserves one-to-one, skilled, safe, compassionate, supportive care. And that means listening. That means understanding the woman, the whole woman, what her history is, what she wants. And that means being able to recognise what straightforward physiological birth looks like and also being able to recognise deviations from that norm and escalating those to the medical team whenever possible. So every midwife is actually trained to do that, you know, to deal with straightforward and complicated birth. But unfortunately, it's not always something that we have the resources to do in the current environment.

7:33As you've alluded to, you have a demoralised workforce, I would imagine. You certainly have a workforce that is working beyond its own individual capacity. I mean, how difficult a job is midwifery before you even consider just how tired some of your colleagues on the front line must actually be day in, day out. It can be an amazing job, but I cannot, as a midwife of over 12 years now, begin to convey to you and the listeners how challenging and how difficult this job is, especially in the current circumstances. It's mentally challenging, intellectually challenging, physically very challenging and emotionally challenging.

8:11and what makes it worse is that midwives are working in very dangerous unsafe conditions a lot of the time in that short staffing is rife midwives very often miss their breaks sometimes entirely for the whole shift many midwives working in community are doing full day shifts and then being called out to cover home and hospital births overnight and then being expected to work again the next day and I think this is a side of the service that the general public aren't really aware of. Absolutely, we should be flagging flaws in the system and absolutely women who have suffered harm should be able to talk about that and that must be addressed.

8:48But it's also really important to talk to the people on the shop floor and understand that they also are broken and they also want safety just as much as the service users do. We're about to enter into a period where there is really going to be a spotlight cast on the state of maternity services across the United Kingdom, not just in NHS England. And I suppose at times like this, if things are going wrong on a maternity ward, the likelihood is that the people who are in the first instance responsible are those who are providing the care in those maternity wards. And the criticism that is going to be coming, I suspect is going to be quite brutal and probably quite difficult for those who work in this part of the NHS to hear.

9:29Absolutely. It's never good to hear that people have suffered harm at the hands of the maternity service and where individuals have caused harm, they absolutely should be held accountable. That must be addressed. But I think what we also need to look at is the general workplace culture, the overarching management culture, and the way that the service has been organised. And that in itself causes institutional harm on a large scale. And I would argue that the way the maternity service is being run at present is a large scale form of obstetric violence. It's nothing short of violence against women.

10:04So while it's very difficult to say that and hear it and put it into that context, if anything, I hope that this upcoming review demonstrates that harm is being done to service users and actually to staff, and that we must address this as a form of violence against women and rectify it fast. Those are incredibly strong words. What can be done then in the very short term to reduce the harms that are being inflicted? We just have to realise fundamentally that birth is a transformative event in public health. It's not just a niche women's issue, not that women on their own aren't important enough, but literally each and every one of us is born.

10:47And actually, roughly half of all babies are just very, very small men. So I think the government needs to recognise, you know, not to be too trite, but the government needs to recognise that maternity is not just a niche service. This is an emergency. This should be a source of national shame, not just for women, but for men, for the government, for every politician, for every legislator, for anybody who determines the budgets and the service provision of maternity. We have to view this as a national emergency and we have to start resourcing it as such very, very quickly. Midwives have been shouting about this for years.

11:26And it's great that, you know, women and service users are now shouting about this as well. But we've seen this crisis coming. It was preventable. We've known it was happening. And now it's well past happening. As I said at the top of the interview, it's past the breaking point. So I'm very, very sad that we've ended up like this, but we saw it coming. Is it just then a question of more money, more staff, or is there a requirement, do you think, in your mind, for better training to shape midwifery and the department for the needs of the 21st century just a little bit better? Well, it's interesting.

12:00I mean, midwifery education has been under attack recently, not always for evidenced, well-founded reasons. Midwifery education is highly regulated. The curricula is, you know, well-established and well-evidenced. So I don't think it's necessarily a matter of training. Certainly there are some of the wrong people in the job, and I'll be the first to admit that. I know that there are some people working in the system who shouldn't be. I think that probably goes for every aspect of the NHS, unfortunately. But yes, we need that kind of cultural sea change that I've suggested. And we need money. Not to be too mercenary about it.

12:36But, you know, this government has reduced the ring-fenced maternity safety fund from£98 million to£2 million. So the math is not mathing. This review will be absolutely toothless and ineffective if it's not backed up by some cold, hard cash. When you say the wrong people might be working in midwifery, what do you mean by that? Well, in health care, you have to be a caring person. You have to be compassionate. you have to be capable of listening, empathising, responding, as well as all the clinical skills that come with the role. I don't think midwifery is unique in the fact that most of us should be in the job and do want to care and do a good job.

13:11But as with any part of healthcare, there will be some who are lacking in compassion or have become so hardened and burnt out over the years that they are causing the kind of harms that you've spoken of. So I don't know what the answer is there, But absolutely, we have to cultivate a more compassionate working culture across the board. How did you get into this as a career? Because it wasn't the first career, was it? No, I came to this a little bit later in life as a so-called mature student, which is actually how many midwives come into the profession. I worked kind of behind the scenes in a not very glamorous job in television and journalism before the birth of my first child, which was such a difficult experience actually that it prompted me to try and figure out you know why is it like this for so many women and I really wanted to be able to make a positive change for other women going through this experience.

14:00I had another child I ultimately made the decision to go back to university and retrain in midwifery which I did qualifying in 2013 and I think what a lot of people forget is that they sort of talk about midwives and mothers in binary terms but actually so many midwives came into the profession because of our experiences becoming mothers and because we want to make things better for other people. So what makes you keep turning up to work then? It's a really good question. I'm as surprised as anybody that I'm still a midwife after 12 years. I have actually had periods in my career where I've decided to step away and to leave midwifery completely.

14:34I've been burnt out, anxious, stressed, depressed, and I've made some real changes to my working habits so that I can engage with the system in a way that is still healthy and sustainable for me. But I recognise that not everybody has the privilege and ability to do that. And indeed, we're seeing that in the mass drop off in retention in our profession. You know, many, many midwives would like to keep turning up every day, but ultimately find that they just can't. Leah, it has been great to have you and your expertise on the podcast. Thanks very much. Thanks. I appreciate it. The documentary we've been referring to can be found over on the Sky News website.

15:12That's your lot for The Daily. We're back again tomorrow.

15:24How does a banana trigger a CIA-backed coup? Do AirPods herald the arrival of a new global order? What do LED lights say about the future of humanity? I'm Ed Conway and in each episode of my new podcast Stuff Matters I take an object crack it open and reveal the world-shaping forces hidden inside This is economics told through the things we think we understand Search Stuff Matters on your podcast app to listen and follow