Seven easy ways to make maternity care safer for women – and save them from the trauma I suffered

“Just get it yourself,” was the answer, the first time I asked for water in postnatal recovery.

“You again,” said another. “You’re supposed to get up and start walking around. It helps.” And just like that, she was gone.

But I could not get up. Thanks to an epidural, I was frozen from the waist down. The midwives had placed all my belongings behind my bed – and the baby just out of reach. Only a plea to bring her closer in order to breastfeed finally made the penny drop that I could not, in fact, even move to feed my own child. It’s been well over seven years, but I see it and replay that callousness in my mind clearly, even today.

As we wait to read the full report from The Birth Trauma Inquiry, I am reminded not just of my own hurts, but of all the maternity reports that have come before. Each one has found the issues of the last compounded. They ring with a familiarity that they should not. We are supposed to be learning from our mistakes, but we don’t.

The thing is, we know how to make a better, safer maternity unit. As part of a research team, I went up and down the country examining what worked (and what didn’t) to understand how to better care for mothers and babies at this crucial time in their lives. We found seven key features that make a maternity unit safe. It is simpler, at first glance, than you would think.

First, there needs to be a commitment to safety and improvement at all levels, with everyone being involved in that commitment. The staff, the unit, the hospital and the trust must sing as one, recognising that a safer unit is a better, happier and healthier unit for staff and patients. Everyone has to get on board the good ship “Safer Care”.

Second, technical competence, supported by formal training and informal learning, is vital. Training is key to safe and compassionate care, full stop. This requires real support, not just lip service from trusts, to protect training time for staff so that they are up to date on skills and learning necessary to provide competent and safe care.

Third, safe units have teamwork, cooperation and positive working relationships as their bedrock. It seems a small thing, but everyone must show in actions and ethos that they want to work together to provide good care. This isn’t always easy in hospitals, where shift patterns can sometimes see people never working more than once a year with each other. But if the first key feature is sound, then this third one holds together too.

Fourth, these units are constantly reinforcing safe, ethical and respectful behaviours towards each other and their patients. Practice something enough and it becomes a habit. The habit of safe maternity units, with good outcomes for patients is to be this way in everything they do and it shows, with these units having fewer traumatic births and avoidable harms.

Fifth, these units use many different ways to identify problems, which are used as a basis for change. Safe units look at themselves from all angles: staff voicing concerns, patient outcomes, staff and patient surveys – the list goes on. These units are not afraid to give themselves a good hard look in the mirror, identify where they are found wanting, and work to change that.

Sixth, much like how staff are supported to have up-to-date training and skills, safe units keep their own systems and processes up to date and review them regularly to ensure they allow for the best possible care staff can give to patients.

Finally, safe maternity units are, because of everything above, able to quickly and effectively mobilise themselves to provide good care. They can coordinate difficult situations and react quickly to serious situations (maternity care is much more life and death than many realise) because they have spent the time to prioritise safety in every aspect of their work.

It should be easy, right? If we know what we need to make a happy, healthy and safe maternity unit, why don’t we do it? Why has there been report after report that maternity isn’t safe? That it is a crap shoot of the highest stakes? Because it takes only one thing to pull the rug out from even the best maternity unit – system-wide failure.

After years of austerity, the NHS is in a condition well beyond critical. Thanks to a complete lack of investment over the last 14 years of Tory rule there are not enough staff to safely run the now crumbling, creaking and ageing wards.

There aren’t even enough hospitals to meet the needs of our population. We could be safe if only the system didn’t let the NHS down, time and time again.

I’ve said it before and I’ll likely write it again, but until politics values our health and social care as a whole – and funds it accordingly – women and their babies will carry on being traumatised, carry on dying (or worse, barely living at all, or in excruciating pain, thanks to their experiences). It doesn’t matter how many key features can make maternity safe, it takes only one neglectful government to topple it to the ground.

Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health and co-director of the Centre for Health and Society at Aston University