Deliver positive change at pace

By Gill Walton, Chief Executive on 14 December 2020 Maternity Safety

The interim report from the Ockenden Enquiry was published last week. It is harrowing reading the accounts of the women and families involved and knowing that they had to wait so long for their voices to be heard. The complex culture that led to those outcomes is not easy to understand and it may be that trying to understand it takes our focus off solutions and positive change. Those families need more than an apology, they need to see change in maternity care happening now and sustained.

I know there have been improvements in maternity care over recent years. What Ockenden is saying is that change is not happening fast enough, and I am inclined to agree. As with any report such as this, fuelled by the media, some of my midwife and obstetric colleagues take it as opportunity to blame each other. This is not helpful and is actually harmful to one of the crucial solutions: working together. I am clear that we have to put our collective energy into using these recommendations as a springboard to a safer future for women and families. This time, though, that springboard needs to be bigger and strong enough to ensure it never becomes flimsy.

The pursuit of normal birth as a preferred outcome has raised its head again. This is the last time I will talk about ‘normal birth’. While we cannot change the normal physiology of pregnancy and birth, that and the ideology of ‘normal birth’ often get confused. Midwives and obstetricians, I believe, want to support women to have a good birth, a good birth that is through the lens of the woman’s experience. What does that mean? A good birth is where women feel that they are at the centre of care, that they have been able to make informed choices, where the risk and benefit of those choices are carefully explained. Every woman has a unique view of childbirth based on their life experience, knowledge, values and a huge array of complex variables. Their choice, after careful consideration of risk and benefit, matters.

I believe that every woman should have a midwife: a midwife who gets to know her and is able to advocate for her and navigate the appropriate care she needs. This is the aspiration of Continuity of Carer, but if we are to improve care for all women at pace, all women must have improved care now. The targets for Continuity of Carer must be removed to open up improvement. It is time to put in substantial building blocks of, firstly, improving antenatal continuity for all as a minimum, and engaging obstetricians in working with midwives to provide multidisciplinary continuity. Secondly, we need to ensure postnatal continuity across the multidisciplinary team, to improve look back at care, understand outcomes and the woman’s experience and to enable future planning. Thirdly, we must guarantee one-to-one care in labour for women in all settings. Finally, services able to provide Continuity of Carer must deliver this to the most vulnerable women in their service.

Maternity services need sustained investment to support the interim Ockenden recommendations: more staff, more multidisciplinary training, strong midwifery and obstetric voices at every level of the NHS and leadership development for all. Most importantly women must be at the centre of care and service development. Positive action, not blame, has to the driving agenda. If we do this together, with focus, we can deliver this at pace. We have no more time to lose.