Birth trauma Scotland: Why mothers have been left feeling frightened, dismissed and traumatised by birth experiences

As the UK’s Birth Trauma Inquiry published its much-awaited report, showing mothers can be left feeing frightened, dismissed and traumatised by their birth experiences, The Scotsman’s health correspondent Joseph Anderson looked at the state of maternity in Scotland

“Women can be replaying giving birth in their head, dreaming about it, not being able to sleep, feeling on edge, feeling like something really bad has happened – and absolutely none of it is their fault,” says Dr Rebecca Moore.

The health expert is explaining how one in three mothers in Scotland have been traumatised by some aspect of their birth story.

She says: “We know that birth trauma is unfortunately really common. As a result of that, women can experience trauma symptoms, which can be present for weeks, months, even years. A smaller number of these women go on to have a diagnosed post-traumatic stress disorder.”

Women described being mocked or shouted at and denied basic needs such as pain relief in some instances, while maternity professionals reported a system in which “overwork and understaffing was endemic”.

Dr Moore was speaking after more than 1,300 gave their emotional – and at times painful – testimony to the UK Birth Trauma Inquiry. The inquiry found poor care is "all-too-frequently tolerated as normal", with women complaining their emotional and physical pains were dismissed, as well as their concerns.

“Lots of things cause trauma in birth, even language,” says Dr Moore.

“Sometimes people feel forced into being induced, they are told they need it and feel coerced. It can be about people feeling their pain is dismissed. It can be physical things – sometimes the baby needs to go to neonatal intensive care without the parents being told why.

“Sometimes the baby needs a little support and they’re absolutely fine. But if they’re whisked away and no one is talking to you, people can think their baby has died.”

Dr Moore adds some others are left feeling they are at risk of death during birth procedures, where clinically they are not, “but no one has communicated to them and they feel frightened and alone”.

The all-party parliamentary inquiry into birth trauma, led by Tory MP Theo Clarke and Labour MP Rosie Duffield, concluded women are often “treated as an inconvenience”. The inquiry made a raft of recommendations, including the creation of a national strategy to improve care.

Among a host of other recommendations in the report was the recruitment and retention of more midwives and the creation of specialist standardised postnatal services to give women a “safe space” to speak about childbirth experiences.

In many cases the inquiry looked at, trauma was caused by “mistakes and failures”, which were “covered up” by hospitals as they frustrated parents’ efforts to find answers, the authors wrote.

Women described being mocked or shouted at and denied basic needs such as pain relief in some instances, while maternity professionals reported a system in which “overwork and understaffing was endemic”.

“The picture to emerge was of a maternity system where poor care is all too frequently tolerated as normal, and women are treated as an inconvenience,” the authors wrote.

In Scotland, the report notes, community-based perinatal mental health services are offered. “There are examples of good practice, such as Scotland’s introduction of a participation officer role, working with health boards and the Scottish Government to gather feedback from women and family members to improve the service,” the report reads.

“Nonetheless, provision is patchy in each of the devolved nations, and all face workforce challenges.”

Asked whether it will implement the recommendations of the report north of the Border, the Scottish Government says it will “carefully consider” the findings and recommendations in the Scottish maternity services context.

“The Scottish Government is committed to continuous improvement in maternity safety across Scotland, in partnership with NHS boards and clinicians and service users, to deliver the best and safest care for mothers and babies,” the spokesperson adds.

In the same week as the birth trauma report, the annual ‘Saving Babies’ Lives’ maternity progress report was published, which highlights variations in staffing shortages across different regions.

“The current scale of pregnancy loss and baby deaths in the UK is not inevitable,” the report reads. “At least one in five stillbirths and neonatal deaths may have been prevented with better care, equating to over 800 babies’ lives in 2022/23.”

The report authors say “insufficient staffing levels have often been associated with poor care and avoidable harm”. But while staffing has increased in some areas, “there are variations in staffing levels between individual services and regions, variation across the year, the skills mix of individuals within each service, and the changing profile of the birthing population”.

The Royal College of Midwives' (RCM) executive director midwife, Birte Harlev-Lam, says the message from the report is “stark and clear”.

“Concerns are not always being taken seriously and this must urgently change,” she says. “The death of any baby is a tragedy, even more so if it could have been prevented.

“Sadly none of the findings of this report are new and they underline what the RCM and our members have long been saying, that staffing shortages drastically impact the safety and quality of care that can be delivered.

“Protected time for training, in particular multi-disciplinary training for maternity teams, is crucial, so maternity staff can better respond to emergencies and mitigate safety risks. Far too often we are hearing of training being postponed due to staff shortages.”

Health secretary Neil Gray says nurses in Scotland “remain the highest paid in the UK”.

“We also provide the highest non-repayable, non-means tested bursaries at £10,000 for eligible nursing and midwifery students – as well as reimbursement of expenses and a range of allowances to support entry to the profession,” he says.

“However, I know that more needs to be done to recruit and retain our valuable workforce and that is why I am chair of the Nursing and Midwifery Taskforce, which aims to build on efforts to make Scotland the best place for nurses and midwives to come to work.”

Mr Gray adds: “Whilst there is a lot of work already underway to support a sustainable and skilled workforce, the taskforce will help us identify gaps and prioritise work, focusing on tangible outcomes that will future-proof our workforce in light of the ongoing demands that our services face.”