Alison, 38, gave birth to her son in June 2021 at a busy London hospital.
“We had exemplary care during delivery, and the midwives looking after me during my antenatal care were likewise fantastic,” she recalls.
“However, I didn’t see a midwife face-to-face between my nine-week intake appointment and my 30th week of pregnancy. Then I saw nobody again until I was 34 weeks pregnant, and the next time I was seen was at 38 weeks, even though you’re supposed to be seen weekly at that stage.”
At Alison’s two-week postpartum check-up, she had to have her stitches examined in a chair as no other facilities were free.
“The ward was so full they’d had to close the birth centre; labour and delivery was full, and I met two women labouring in the early stages of their induction in the hallway. The midwives that came to do home visits were rushed and left me in tears every time,” she says.
All NHS staff she came into contact with throughout her maternity care were clearly overworked, Alison says, but doing their best.
“There was just no availability on the system, no capacity.”
Alison’s experience chimes well with my own. When an A&E doctor explained calmly last June that I was suffering from early pregnancy malaise, I reluctantly decided to go back to the London hospital where I had given birth eight years before.
My high-risk twin pregnancy had ended in premature birth at 24 weeks and tragedy – with one baby dying after a three-month battle in intensive care. Throughout my antenatal journey, crucial appointments had been cancelled due to staffing issues, with the result that nobody picked up on early signs of premature labour, until it was too late for intervention.
My hopes of receiving better care this time, assuming the trust would be aware of my history, evaporated quickly. By nearly 15 weeks of pregnancy, I had still not been seen by anyone, with text messages supposed to inform me of appointments failing to arrive.
When I queried why I had been given a date for a scan two weeks after the latest possible date such a screening could give a diagnosis of chromosomal abnormality, a clinic receptionist told me I should go private if I didn’t like my appointments. A complaint triggered an apology from the trust’s chief executive months later for protracted problems in the booking process, as well as an apology from the deputy head of midwifery for the receptionist’s “inappropriate” advice.
By then, I had forked out hundreds of pounds for a private scan and private appointment with an obstetric consultant at the hospital. I was promptly referred for specialist antenatal monitoring on the NHS, and have received excellent care ever since, but plagued by the knowledge that my ability to pay had got the ball rolling.
Kerrie, 31, a solicitor from Leicestershire, is one of hundreds of women who responded to a callout I launched via Community, the home of readers’ content on the Guardian and Observer’s website. I wanted to find out how others had experienced NHS maternity care in England over the past year, but I was taken aback by the sheer number of responses from virtually every corner of the country.
Like me, Kerrie saw no other way but to shell out hundreds of pounds for private scans during her pregnancy last year, as her trust only offered her appointments outside the windows in which they could be performed.
“Every scan was beyond the normal NHS care timescale. I couldn’t have an NHS scan for Down’s syndrome because I was only offered a date after 14 weeks of pregnancy, which is too late,” she says. “My only option was to go private, according to my midwife, who recommended a screening that cost £450.”
All Kerrie’s midwife appointments also took place later than they should have. When there were concerns for her baby’s growth in her second trimester, she waited nearly two weeks for a scan that should have happened within 72 hours.
Last summer the Care Quality Commission’s chief inspector of hospitals told a parliamentary inquiry that inspections had found that 38% of NHS maternity services “require improvement for safety” – more than in any other medical speciality. A report by the Commons health and social care committee on maternity safety in England subsequently concluded that staffing numbers are the most essential building block in providing safe care, and that progress is urgently needed as far as continuity and personalisation of care is concerned.
But in many parts of the country the pandemic appears to have reduced NHS capacities for well-run maternity provision in the long term. Hollie, 30, from Staffordshire, who is expecting her second child, found that lack of continuity was precisely what made her antenatal care problematic. “It has been minimal and lacking, purely for the fact that midwives are understaffed and overworked,” she says. “In 30 weeks of pregnancy, I met my real midwife once, but saw four other midwives who knew nothing about me, so appointments were all a repeat of the last one. I rarely got a chance to voice my concerns.” Her local hospital stopped its childbirth services during the pandemic, so her nearest hospital is now more than 40 minutes away.
“I’m being sent all over Staffordshire for appointments. I don’t drive and have a four-year-old – the whole situation is very stressful. Compared with my first pregnancy, I’m finding it incredibly difficult to get the support I need,” Hollie says.
For some women, draconian Covid regulations in hospitals and serious staff shortages have led to highly traumatising experiences.
Rachael, 31, from Deal, Kent, is still processing the birth of her son, Ollie, in June 2021.
“I felt really let down,” she says, “although I am extremely grateful that Ollie was born safely with the help of hard-working professionals.”
Her 33-hour excruciating labour was marred by disagreements between doctors and midwives, poor communication and agonisingly long waits in corridors due to capacity issues. “I felt brutalised. I was in so much pain. I don’t want to scare prospective mums, but it really wasn’t OK. I do feel that understaffing affected my care, communication, but also compassion.”
Gemma, 34, from Woking, Surrey, gave birth to her second child in September 2020. Although she had significantly less contact with healthcare staff than in her first pregnancy, and was unnerved that many appointments happened over the phone, she found the care leading up to the birth OK.
“The birth, however, was the single worst experience of my life,” she says. “Partners were not allowed in until active labour, so I was induced on my own. Staff refused to touch me to comfort me because of Covid, and due to understaffing I was left alone for hours, in the dark, without pain relief. I was crying for help, but nobody came.”
Edyta, 37, a healthcare assistant from Rugby, had a similarly “appalling” birth experience. “The maternity ward was so understaffed it felt dangerous. On my first night on the ward, a nurse came and said, ‘I apologise in advance in case you’ll feel abandoned, but it’s just me and one healthcare assistant.’” Like nearly all those who got in touch, Edyta blames staffing levels, not staff. “There are not enough of them, and they are run into the ground. It has put me off wanting another baby for now, but if I was to have more in future, I would consider going abroad to give birth, where going private is cheaper.”
Jon Skewes, executive director for external relations at the Royal College of Midwives (RCM), said: “Countless independent reviews of maternity services have cited staff shortages as a potential risk to safety and quality of care. The RCM has been raising concerns about this for over a decade, yet successive governments have chosen not to listen. There are massive pressures on maternity services and the wider NHS because of the pandemic. That has meant sometimes some services had to be adapted or restricted, such as fewer in-person appointments. All these decisions were made with a heavy heart because midwives know how important this is to women.”
An NHS spokesperson said: “Despite pressures and the impact Covid has undoubtedly had on staffing, the NHS remains one of the safest places in the world to give birth and services have continued to see women and their babies throughout the pandemic. In addition, the NHS has invested a further £95 million this year to boost workforce numbers, training and leadership.”
