Afterwards, a healthy baby wrapped beside me, all I felt was wonder and gratitude. My daughter’s birth seemed miraculous, every single person involved a saint. The NHS had saved my baby. 

Forget the water-birth I had planned but never got. My C-section was the single most positive day of my life.

But how lucky was I? While the majority of women in the UK say their births were positive experiences, too many have anguished memories of not being listened to, of their trust letting them down, of babies who were not saved.

Today, the results have been published of the long-running Ockenden Review into maternity services at the Shrewsbury and Telford Hospital NHS Trust – scene of one of the biggest scandals in NHS history.

Its findings, amassed by a team under Donna Ockenden, a former senior NHS midwife, are shocking.

The report encompasses the experiences of 1,862 families between 2000 and 2019 – almost certainly the largest clinical review into a single service in the history of the NHS.

More than 200 babies and a nine women died unnecessarily in the Trust’s care. Failures in care and governance were repeated over and over again: indeed, the review’s interim report, published in December 2020, catalogued catastrophic failures, including ‘continuous errors in the assessment of fetal wellbeing’ and ‘failure to recognise and escalate the management of deteriorating mothers’.

Between 2013 and 2016, stillbirths and early neonatal deaths at the Trust were up to or more than 10 per cent higher than comparable UK NHS Trusts.

But what the report also exposes is a wider, more insidious problem: the creeping influence in the health service of a movement that promotes “natural” or “normal” birth above modern obstetric science.

It is a tragic paradox that what began decades ago as an attempt to make childbirth a happier experience for mothers has instead made it more dangerous for some. 

How the cult of natural birth took hold

Back in 1960, after giving birth in a Hertfordshire NHS hospital, a mother called Sally Willington wrote a scathing letter to a newspaper recounting her experiences.

‘In hospital, as a matter of course presumably, mothers put up with loneliness, lack of sympathy, lack of privacy, lack of consideration,’ she wrote. ‘Our maternity hospitals are often unhappy places with memories of unhappy experiences. They are overcrowded, understaffed and inhuman.’

In the early years of the NHS, after its foundation in 1948, many babies were still born at home, as they always had been. There simply weren’t the resources for hospital births except when complications were expected.

Investment in the NHS – and advances in obstetric science – led to a revolution in midwifery. By 1963, 68 per cent of all births were in hospital instead of at home (and would rise to 91 per cent by 1972).

This modernisation was celebrated as one of the great advances by the NHS in improving the nation’s health.

But for mothers like Willington, an artist and activist, the dramatic medicalisation of childbirth left them feeling like spectators – or even unwelcome guests – at this most intimate and significant event in their lives.

Willington wanted to restore women’s agency and dignity by getting rid of unnecessary medical interventions. And it worked. Her letter gave rise to a new organisation, the Association for Improvements in the Maternity Services (AIMS), which helped to introduce more humane NHS policies – fathers came into labour rooms, routine humiliations such as pubic shaves and enemas were abandoned.

The revolution did not stop there, however. While Willington had pushed successfully for a rebalancing of medical science and human kindness in maternity units, another more radical campaign was soon being waged by champions of women’s empowerment.

Their target was male obstetric interference, and their goal was a return to nature. Medicalisation disempowered mothers, they argued, and natural childbirth could put modern woman back in touch with her primal power.

This legacy of the social upheavals of the 1960s and 1970s is still with us. Over the past half-century, a whole industry developed around encouraging women to keep doctors at bay. Breathing exercises, birthing suites, hypnobirthing classes all proliferated.

Caroline de Costa, a professor of obstetrics and gynaecology, sums it up scathingly in her book The Women’s Doc (out this June): “If pesky doctors and midwives would just leave women alone they would get on with it. Lambs would gambol in green fields and Judy Garland would sing Over the Rainbow as the baby’s head crowns gently, with nary a tear in the perineum.”

By 2013, when I was pregnant with my daughter, the means through which your baby exited your body had become a highly charged topic. Did you deliver in theatre, too posh to push? Or in the birthing pool, like an Earth mother? My friends and I knew which carried the most kudos. My goal was an unmedicated water birth in the midwife-led unit, far from the men in white gowns.

I took meditations and yoga classes to help me through contractions, which should, I was told, be experienced as ‘pressure’, not ‘pain’. While no one would judge our personal choices, our antenatal teacher said, we should know there was a correlation between mothers who accepted pethidine as pain relief, and children who grew up to be drug addicts.

It was as if we had been momentarily blinded to the fact that, before medical interventions were developed, childbirth was highly risky for both mother and child in Britain (and remains so for many millions of women in developing countries, who would welcome a doctor at their side). Only very recently has modern medical science – antibiotics, ultrasounds and more – made it significantly less dangerous for those lucky enough to have access to them.

Yet at the turn of the millennium,  parts of the NHS were being co-opted into a similar narrative, at a time when the rising rate of caesarean sections was causing concern.

C-sections were considered expensive, resulting in long recovery times for mothers and depriving the baby of the benefits associated with vaginal delivery. In 2005, the Royal College of Midwives launched a campaign to encourage expectant mothers to have “normal births”. Maternity units were asked to keep the Caesarean rate to about 20 per cent.

But what were ‘normal’ births? Swiftly, they became synonymous with ‘natural’.

So when it emerged in 2011 that C-section rates in Shropshire (Shrewsbury and Telford Hospital NHS Trust’s backyard) were the lowest in England, the Trust openly boasted to a local paper about “an environment which encourages natural childbirth and a wide range of strategies to keep caesarean deliveries low”. It was given a pat on the back by both the Care Quality Commission and the Royal College of Obstetrics and Gynaecologists.

Some mothers may have seen the NHS using that word ‘natural’ and considered it evidence that the trust was a safer place than many in which to labour. Behind the myth of ecstatic water-births powered only by smoothies and the sound of whale-song, however, lay a grim truth that Ockenden has laid bare:

“A woman was in agony but told that it was ‘nothing’; staff were dismissive and made her feel ‘pathetic’. This was further compounded by the obstetrician using flippant and abrupt language and calling her ‘lazy’ at one point.”

The scandal Ockenden dissects has nothing to do with mothers being too lazy and everything to do with women who – in pregnancy or labour – either voiced grave concerns that were discounted or displayed warning signs that were overlooked. They were disempowered not by having obstetric interference forced on them, but denied to them. And with devastating consequences.

“There were  cases where an earlier recourse to caesarean section rather than a persistence towards a normal delivery may well have  led to a better outcome for mother or baby or both,” Ockendon told Panorama in a documentary aired in February. “Low caesarean section rates were a prize.”

The call for ‘normal births’ was so loud that it drowned out the concerns and symptoms of individual women. One mother, Rhiannon Davies told clinicians at the Trust in 2009 that her baby’s movements had reduced, but she was told she simply had a lazy baby and was admitted to a midwife-led unit to give birth. This meant that when her baby, Kate, was delivered in need of urgent medical attention, the nearest doctors were 45 minutes away. Six hours later, Kate died.