A mixed bag of emotions: the APPG published its report
It’s been a big week for birth trauma. And we hear you when you say it’s felt hard going. Our supporters have shared so many contrasting emotions and we hope to capture you all as we share our reflections on the APPG report today.
The All Party Parliamentary Group (APPG) for Birth Trauma co-chaired by Theo Clarke MP and Rosie Duffield MP published their report from their Public Inquiry on Monday morning. Unprecedented press attention for birth trauma followed.
Meanwhile on Tuesday and Wednesday, we welcomed incredible speakers to our Summit stage for the 9th year running. Our biggest Summit yet reached almost 350 attendees. A landmark we’re enormously proud of.
Understandably, the report's publication heightened emotions for everyone involved in our Summit. We were honoured that everyone involved respectfully held space for honest, vulnerable and courageous conversations. Watch our heartfelt closing words from our Co-founder Dr Rebecca Moore here.
As a team we’ve spent this week digesting the recommendations whilst listening and reflecting on the responses from both parents and professionals.
The report themes and our role at MBB
The report makes a shocking read as the raw and heartfelt testimonies of parents affected by birth trauma take centre stage. If you haven’t read it you can access it here. Remember to go gently when you do and step back if it feels too much.
It includes 13 headline recommendations for policy change and 28 in total. The inquiry received more than 1,300 submissions from people who had experienced a traumatic birth, as well as nearly 100 submissions from maternity professionals. The report itself very much reflects the testimonies from the submissions of parents and 9 themes were identified:
Failure to listen
Lack of informed consent
Poor communication
Lack of pain relief
Breastfeeding problems
Lack of kindness
Postnatal care
The impact of Covid-19
Complaints and medical negligence
We’re certain just this list alone will resonate with many. The themes reflect many of the different causes of birth trauma which we try to educate around every day.
At Make Birth Better our role in this work has been:
Our CEO Nikki Wilson was invited to sit on a Special Advisory Group (SAG) alongside Secretariat Kim Thomas (CEO of the Birth Trauma Association), Chloe Oliver (CEO of MASIC), Laura Seebohm (CEO of the Maternal Mental Health Alliance), Gill Castle (a phenomenal birth trauma campaigner also known as Stoma Chameleon) and Mumsnet
We put forward expert witnesses for the 7 evidence sessions which ran in Parliament where testimonies from both parents and experts, including maternity professionals and academics, were shared with members of the APPG
Our Training Lead Trudi Webber worked alongside a cohort of our Champions and other volunteers who read every one of the 1,400 submissions sent in. Our Director Sakina Ballard offered reflective practice sessions for this group.
Secretariat Kim Thomas wrote the report and has spent a year working voluntarily alongside Theo Clarke MP to make this happen. We appreciate this time given by Kim and the emotional labour of everyone involved.
We are particularly supportive of the recommendations related to the points listed below:
Training for professionals
Support for professionals
Screening for birth trauma
Maternal Mental Health Services (MMHS’s)
Birth Listening Services
Partners
Trauma-informed antenatal education
Interpreter provision
Research into the costs of birth trauma
However, we do think think the report misses some vital points which we address further down. We also would have welcomed being able to review and advise on the report before it was published. We strongly welcome the open letters which have been sent to the APPG by AIMS and also Birth Rights activist Emma Ashworth. Both of these letters identify major issues with the publication and call for amendments to be made.
The government response
So far in response to this APPG, the Parliamentary debate chaired by Theo Clarke in October 2023 and the latest report, the following governmental commitments have been announced:
Inclusion of birth trauma as a priority for year 2 of the Women’s Health Strategy
A comprehensive national maternity strategy bringing all programme, report and strategy documentation into one centralised place
NHS England will co-produce new decision-making tools with new mums* to help guide through choices on how they give birth, what interventions could happen and what pain relief they should be offered
The Department of Health will ensure that Maternal Mental Health Services are rolled out to the 3 remaining Integrated Care Boards (ICB’s) which do not yet have one
National Institute for Health and Care Research (NIHR) will be commissioned to do new research into the economic impact of birth trauma, including how this affects women* returning to work
Meanwhile they have also emphasised the importance of ongoing support for:
A standalone GP appointment 6 to 8 weeks after giving birth for a mother* to explore both their physical and mental health (read more here)
National roll out of OASI care bundle across all NHS Trusts (read more here)
National roll out of Maternal Mental Health Services - now sitting devolved as an ICB responsibility
National roll out of perinatal pelvic health services (read more here), including guidance to better support women* who experience serious tears and to prevent these from happening in the first place
Men’s Health Task and Finish Group - the June session will be chaired by Minister Maria Caulfield, and will focus on dads’* mental health and trauma so they can better understand how to support partners
*NOTE: this is the language from the report. We were saddened by the lack of inclusive language in the report, which is written focusing on a cis / heteronormative model of ‘mums and dads’.
Our reflections at MBB
So, that’s the overview of the process and the report’s recommendations, what are our thoughts on this at Make Birth Better?
We have been proud to think that we’ve played a part in the national debate and conversation which has unfolded this week. There has been marked progress in people understanding even the two words “birth trauma”. Improved awareness is a critical part of our success in reducing suffering.
As you will all know, we’re unique at Make Birth Better because we are here for both parents and professionals. We are here to listen to all voices, in particular those of marginalised groups, so that together we can make birth better for all.
This week, on our socials, at our Summit and in our inboxes, we have seen a complete range of reactions. This is very understandable when we’re talking about the fundamentals of human rights, with so many involved (millions in fact!).
“One of the speakers today said ‘We feel heard, we feel valued’, but I don’t. I feel invisible, unseen and ignored”
Marginalised voices
Inclusive language and acknowledgement of ALL who give birth
When you look at birth trauma, research clearly shows that those from marginalised communities are more susceptible to be impacted by birth trauma. Which is why we advocate so much for these voices to be included.
The lack of inclusive language in the report feels incredibly harmful. We share the upset from our friends in the LGBTQIA+ community. Despite interviewing expert witnesses who arelesbian, queer and trans, the public enquiry has not used inclusive language in the report. Instead, it focuses on the cisgendered heternormative model of 'mums and dads'.
These words from our wonderful training partner Jacob Stokoe say it all:
“I was so proud to be in the houses of Parliament to take part in the APPG on Birth Trauma, but I'm so frustrated at how gendered the final result is.
I'm so glad we're listening to women, but we should also be recognising that not everyone who gives birth is a mum and that trans and non-binary people who give birth are not only at risk of birth trauma, but at *higher* risk - especially if we experience multiple marginalisations.
I'm at the launch today and it's hard to be here. One of the speakers today has said "We feel heard, we feel valued", but I don't. Sitting here in a space talking about birth, as someone who has given birth and experienced birth trauma I feel invisible, unseen and ignored.
I'm quoted in the document, but even the title of the document either excludes or misgenders me.”
Cultural sensitivities
When looking at the recommendations to address the racial disparities in maternal outcomes, we also felt disappponted and have listened to those who feel they are too reductive.
The two recommendations which are seeking to address the racial disparities in birth trauma cover Vitamin D usage and improved interpreter provision. As we know we will not solve worse outcomes for Black and brown bodied people unless we name and address the systemic issues, including institutional racism, which cause these problems.
A fully embedded interpreter service is needed across the NHS (whether that’s for Black or brown people or white people) but this is one small action which skirts around the endemic issues. What about all the Black and brown people who don’t need interpreters but still face worse outcomes due to systemic racism? We need to go much further and much deeper to address birth trauma and maternal mortality in racially minoritised groups.
We acknowledge that a seperate APPG (the APPG for Black Maternal Health) has been making demands to end maternal disparities for Black women and birthing people. But we think this is a missed opportunity to align the asks of APPG’s working in the maternity space.
We would’ve liked the report to have endorsed the recommendations from these reports: Systemic Racism, Not Broken Bodies (by birthrights) and The Black Maternity Experiences Report (Five X More). Both reports made recommendations to improve inequitable outcomes for Black and brown birthing women and people over 2 years ago.
It’s also notable that the demand made by the the APPG for Black Maternal Health to the Department of Health to commit to reducing the statistic that Black women are 4 times more likely to during or up to one year post pregnancy, was rejected. Emphasising the point that change will only come if we work together.
“We cannot address the prevention of birth trauma without addressing support for professionals”
Professional voices
From professionals we’ve seen a mixed response - from “feeling hopeful for change”, “great we are listening and shining a light on these experiences” to “not surprising”, “feeling attacked”, “incredibly hard to hold”, “feeling tired and burnt out”. Often professionals feel this mixed bag of emotions within themselves.
We cannot address the prevention of birth trauma without addressing support for professionals.
There are recommendations in the report calling on the Government to further invest in maternity staff and staff wellness. However as yet there has been no comment by Government on these calls beyond a tokenistic promise in the spring budget for a further £35m towards maternity staffing. The total investment promised by the Government still falls way short of what the Health & Social Care Select Committee suggested (which is £250-300m as an increased annual ongoing fixed commitment). An issue we address with our #NoMoreExcuses campaign here.
We’ve also heard some push-back on the OASI care bundle. This intervention has been endorsed by Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynecologists (RCOG) as a method to reduce the incidence of tears. The bundle has always been contentious for some professionals who are fearful that blanket approaches are not a solution to birth trauma prevention.
These voices believe the focus should be on individualised care and that it must be emphasised that the care bundle should only be used in a trauma-informed and culturally safe way where its use is discussed with pregnant women and people and consent is embedded. We agree wholeheartedly with this.
“This inquiry has felt validating for many”
Parent voices
The recommendations, press coverage and the report publication are largely welcomed by a majority of hurting and healing parents. To illustrate the importance of the Inquiry: it heard testimonies from people who suffered their trauma many decades years ago - some are only just telling their stories for the first time. So from a large group we hear that they are feeling “validated”, “hopeful” and “thankful”. This is really important.
Psychological safety has been a concern for Make Birth Better in the process of the Inquiry. The importance of this is clearly reflected in responses from parents who say they have felt “tearful”, “re-triggered” and “angry”. For people to share their stories in a way which keeps them feeling safe, much more psychological support is needed.
We have also heard the voices of parents, and professionals who are angry and critical because they feel this has been happening for too long. We hear things like “Why aren’t these basics already happening?”, “Why is the press making this look like a new story / issue?” and “Yet another report, what’s the point?”
Our conclusions on the report
It cannot be underestimated what the impact of governmental focus and mass media headlines has on the fight to reduce suffering from birth trauma. Whilst it’s always tough to read these stories, it’s in doing so that many realise that they are not alone and begin to seek the help they need.
However, when keeping in mind all of the voices and organisations we work with, we do feel the report and its recommendations could have gone much further and should have been written in an inclusive way. We also acknowledge and apologise for the harm some marginalised groups have experienced from being part of the public inquiry.
Nikki has told us that there was an ongoing grapple with the enormity of the systemic issues during conversations within the Special Advisory Group involved in the report. The systemic problems were recognised and shared, particularly in the expert witness sessions, and the report attempts to address them in the ‘vision’ section.
However we do feel there should have been more emphasis on these foundational problems. Donna Ockenden said as an expert witness that if the foundations are broken, the house falls down. We need to address the foundational problems: institutional racism, misogynistic practice, maternity settings which are not culturally safe or inclusive, toxic leadership which silences professionals. The list could go on. Without this you risk your solutions being more (re)traumatising and adding to the cycle of trauma between parents and professionals which already exists.
We promise to keep fighting for everyone affected by birth trauma. We promise to always return to our Make Birth Better model which keeps us focused on the vital importance of systemic change. We promise to take anyone and everyone who wants to come, along with us.