No-one could fail to be moved by the recent picture in the news of Rhiannon Davies and her beautiful baby Kate, who sadly died after being born at Ludlow Community Hospital in 2009, and our heartfelt sympathy goes out to Rhiannon, her partner Richard and all those families affected by poor maternity care at Shrewsbury and Telford NHS Trust.
Even since yesterday’s news reports, other families have come forward to report devastating experiences at the Trust, with one woman saying “If they had listened to me, I don’t think I would be telling this story”.
Let’s remember that the current round of news stories is based on a leaked interim report from February 2019 that was “not meant for publication”, and Donna Ockenden and her team need to be given the breathing space to deliver the “single, comprehensive report” that the families have asked for.
What is already clear, however, is that human rights centred care; that treats a pregnant woman as worthy of respect, and uniquely qualified to make the best choices for her and her baby; needs to be at the heart of improving any maternity service.
This may sound like motherhood and apple pie but there is a risk that when unsafe maternity care is flagged, in addition to constructive reflection and meaningful action, the straightjacket for choice comes out of the cupboard, and Shrewsbury and Telford NHS Trust and Telford CCG have shown a tendency to use it.
One of the concerns allegedly contained in the leaked report was that Rhiannon Stanton’s pregnancy should have been flagged up as high risk and that she should not have been giving birth in the Ludlow freestanding midwifery-led unit. If Ms Stanton did not have a meaningful two way conversation about the risks and benefits of a freestanding unit in her situation, this is indeed cause for concern. And the resulting ordeal the whole family went through sounds horrific. But local campaigners have told us that Shropshire’s freestanding units are highly valued by women, where the rural nature of the area limits home birth options, and the long drive to the nearest obstetric unit is not risk-free. In the last three years the choices available to women in Shropshire have reduced considerably. We wrote to the Trust in 2017 regarding the “temporary” closure of Ludlow, Oswestry and Bridgnorth freestanding midwifery-led unit. A consultation on their permanent closure is expected shortly. Furthermore Shrewsbury midwifery-led unit is currently undergoing essential maintenance work. Ironically this has coincided with the implementation of Better Births, the national maternity review, which advocates for all four places of birth (home, freestanding midwifery-led unit, alongside midwifery-led unit and obstetric unit) to be available to women.
In addition, a Birthrights Freedom of Information request in 2018 revealed that Telford Clinical Commissioning Group (CCG) had unilaterally decided to stop funding maternal request caesareans. Well almost unilaterally – the CCG had consulted some local obstetricians and Oxford CCG whose local Trust’s policy on maternal request caesarean is infamous for being completely unsympathetic to women. However the CCG had no qualms about taking this decision without consulting the women who would be affected. We are aware of women who have put off trying for a baby, because they do not feel safe to become pregnant as a result of this policy.
On social media, the calls for heads to roll abound on the back of the latest stories. Yes healthcare professionals who deliver negligent care must be accountable for their actions. And some of the care described in news reports is truly difficult to comprehend. Maternity care in any Trust can only be improved by a focus on listening to women and supporting staff to deliver an individualised and compassionate service. Funnelling every woman onto a narrowed conveyor belt of care is not the answer.
We are encouraged that Donna Ockenden and her team’s first priority is to listen to the families affected. Despite their remit stretching way back to 1979, we hope that the team will be taking a hard look at maternity services as they are today, and how they need to change to offer truly safe AND personalised care in the future. We are confident the answer will be human rights centred care.
Thankyou for this. Many of us are fearful that the report and outcome will further undermine the care and choice women have in this rural county. MLUs ensured women had a hub of professional midwifery care that could then be escalated as necessary. The removal of this has both low and high risk women some with limited childcare and transport options forced to travel long distances for any professional care especially at night. It is tragic for women and staff. Dedicated staff are being forced to work in ways that are not women centred and not how they choose and are bullied and hounded if they seek to challenge. As someone who lives on the other side of the border in rural powys we watch in wonder with our lovely network of MLUs and continuity of care showing it can be done. Complexity is the name of the game here, listening and responding to the different needs and choices of women is imperative. This has not happened in the past. Rather the reverse. But, and there is a big but: the terrible cuts and financial situation for shropshire healthcare has a hand in this too.