At Shrewsbury and Telford Hospital Trust, 300 newborn babies died or were left brain damaged, while at least 12 mothers died giving birth. An inquiry into this scandal led by the senior midwife Donna Ockenden will publish its report this week. It has reportedly uncovered a dreadful and unforgiveable situation between 2000 and 2019.
Women were denied caesarean sections even when they pleaded for them. Mothers were routinely overmedicated to bring on contractions leading to vaginal delivery. Doctors used excessive force to deliver babies, leaving many with fractured skulls and broken bones. Others were starved of oxygen and left with life-changing disabilities. Hundreds were stillborn, died shortly after birth or were left brain-damaged.
The main reason was an obsession with natural birth, which discouraged caesareans and put enormous pressure on women to have vaginal deliveries. This obsession developed during the 1980s as part of a wider movement that believed everything natural or organic was good while man-made or artificial interventions were bad.
Organisations such as the National Childbirth Trust argued that birth was a natural process and women ought to be supported to deliver their babies naturally. Medical intervention was regarded as a male, technological intrusion into a female rite of passage which depended on women’s traditional wisdom and experience.
This orthodoxy was dominant when my own children were born. As I was in the last stage of labour with one of them, the midwives literally shut the door on the doctor when he put his head in to see if he could help. Yet it was more than just a women-against-the-patriarchy thing. There was also a strong sense of oneupmanship among other women if you could boast about having a natural birth with minimal pain relief. You were made to feel a failure if you had an epidural anaesthetic, let alone a caesarean. The irony of Shrewsbury, of course, is that the avoidance of caesareans often involved significant medical intervention in births that were anything but natural.
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The Shrewsbury horror teaches us a number of important lessons. The first is about the way the NHS is run. Once again, it closed ranks here against the mounting evidence of negligence or worse. Families that tried to raise their concerns were silenced or ignored. Worse, precisely the wrong conclusions were being drawn. By 2002, the trust had the lowest caesarean rate in the country and was accordingly praised by the Commons health select committee.
From 2006 to 2018, the trust’s rate was eight to 12 per cent lower than the UK average of about 30 per cent. But, tellingly, between 2013 and 2016 mortality rates in the trust’s maternity and neonatal services were at least 10 per cent higher than at comparable hospitals. Yet the local clinical commissioning group, which ordered its own review of maternity services in 2013, concluded they were safe and of good quality. Even when bereaved families started to bring forward compelling evidence of gross failings in maternity care, Simon Wright, the trust’s chief executive, claimed this was “scaremongering”.
It seems to be in the health service’s DNA to cover up its errors. Whistleblowers have been repeatedly victimised, and patients and their families who complain often encounter obstacles and threats. Staff look upwards through a toadying chain of command to politicians who require them to uphold the NHS mythology that it’s the most caring, compassionate and effective health provider in the world.
The Shrewsbury disaster also demonstrates the way in which ideological dogma not only grips the minds of the gullible and conformist but can also erode the supposed safeguards of professional training.
Other dogmatic fads have similarly distorted public services, to the grievous disadvantage of those who use them. In the 1980s, mentally ill or handicapped people were effectively abandoned in the community on the basis that it was unhelpful or cruel to keep them in hospital. “Child-centred” education, under which teachers were reduced to being mere “facilitators” of their pupils’ “unguided discovery learning”, abandoned countless children to floundering ignorance. And of course, today’s transgender dogma has subjected a horrifying number of children to harmful and sometimes irreversible physical changes.
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With the natural childbirth orthodoxy, doctors and midwives not only junked clinical understanding but denied the evidence of their own eyes when a baby or mother was in danger. By the early 2000s, this obsession was no longer confined to the domain of ecological ponchos, yurts and unshaven armpits but had taken over the clinical establishment.
In 2007, the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists and the National Childbirth Trust signed a statement pledging to work towards a 60 per cent natural birth rate in hospitals. The NHS regulator, the Care Quality Commission, fell down on its own job when it similarly praised hospitals with high rates of vaginal birth and criticised those with above-average caesarean rates.
Last year, the OECD ranked the UK 27th out of 38 countries for infant mortality and 20th for maternal mortality. As with the Mid-Staffordshire Trust scandal, where hundreds of elderly patients were neglected, starved and dehydrated, it’s yet another example of the lethal gap between the sentimentalised glorification of “our NHS” and the inadequate reality. This has absolutely nothing to do with resources but involves instead power relationships, mythologies and minds that are closed.
