UK maternity scandal and the danger of dogma

Published : 05 Apr 2022 10:47 PM

A five-year investigation into the avoidable deaths of 201 babies and nine mothers at a U.K. hospital — described by one British newspaper as “the worst maternity scandal in history” — has ignited a debate over health care that has ramifications outside of Britain. 

The official report by Donna Ockenden, a senior midwife and businesswoman, revealed this week that the health of expectant mothers and their babies was sacrificed to dogma. Former Secretary of State Jeremy Hunt, who ordered the inquiry five years ago, says “the natural birth ideology ... proved to be absolutely catastrophic at Shrewsbury and Telford.” That hospital’s refusal to admit initial mistakes was another main factor. It does not continue to stand by those policies.

At Shrewsbury and Telford hospital trust, Debbie Greenway was one victim. When she asked for a caesarean section — her twins had with difficulty been conceived by IVF — the doctor repeatedly dismissed her request: “We’ve got the lowest caesarean rates in the country and we are proud of it and we plan to keep it that way.” After an extended period of labor, Greenway lost one of her babies and was told it was a highly unusual occurrence. It wasn’t. 

Greenway’s natural birth followed repeated doses of syntocinon, a drug used to bring on contractions after her extended labor. An earlier caesarean would likely have saved the life of the baby she had already named John. 

Many other mothers-to-be were given similar brush-offs at Shrewsbury. No whistleblower at the hospital alerted the authorities when death rates rose and babies were permanently damaged by unnecessary forceps deliveries. It took a campaign by a few brave families to prompt a health minister to order an official inquiry after years of stonewalling. Ockenden reported that “a culture of reluctance to perform Caesarean sections resulted in many babies dying during birth or shortly after their birth.”

The scandal began with well-intentioned but unscientific thinking. In the 1980s, concerns grew that childbirth was being over-medicalized, especially by arrogant male doctors. Health lobbies began to advocate for fewer interventions. This development, it could be argued, was a course correction. 

But in 1985, the World Health Organization briefly threw its authority behind natural birth, declaring that health services should limit caesareans to 10-15% of all childbirths. By 2007 in Britain, that preference began to harden into dogma — despite the WHO’s swift withdrawal of its ruling. The Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the National Childbirth Trust set a target of 60% “normal” childbirths in U.K. hospitals.

Soon it became fashionable for natural birth propagandists to sneer at successful women for being “too posh to push,” by electing for a caesarean. There was also pressure by some midwives on expectant mothers to give birth without the pain relief provided by epidural injections. This echoes a larger problem in health care of women’s pain being taken less seriously. Caesareans are not cheap, so hospital managers had a perverse incentive to restrict operations too — just as their predecessors in the NHS in previous decades had saved money by ejecting mental patients from their wards. (C-section rates vary across the developed world.

Mortality rates in the hospital maternity services rose more than 10% above the national average. Yet according to Ockenden, two Clinical Commissioning Groups in 2013 gave the Trust a clean bill of health. That report stated that “there is a robust approach to risk management, clinical governance, and learning from incidents. It is clear that Shropshire has a maternity service to be proud of and that the model of service provision is safe and robust.” 

Good hospitals measure, manage and hold clinicians to account through reviews and best-practice benchmarking. But what if higher medical authority subscribes to health fads too, willfully ignoring the evidence of failure?

Despite the Ockenden report, three other hospital trusts continue to promote vaginal births over c-sections. An advertisement for Keighley Yorkshire Trust says “successful candidates will be able to demonstrate their commitment … promoting the normal birth pathway and reducing interventions.”

The best health-safeguarding systems in the world won’t work if there are perverse incentives — such as misguided c-section targets and financial rewards — to override them. More maternity units across the U.K. are now being investigated by the department of health. Fear the worst.

Martin Ivens is a director of the Times Newspapers board.

Source: Bloomberg