Reimagining Safety in Maternity Care

After spearheading Birthright’s Home Birth campaign, our Policy and Campaigns Manager Elif Ege reflects on how ‘safety concerns’ are too often used as an excuse to restrict or suspend maternity services… 

What do hospitals and Trusts mean when they talk about safety?

Last month at Birthrights we launched our report Access Denied on restrictions to and suspensions of home birth services. As part of our research, we wrote to all 145 Trusts which provide maternity care across the UK.  In the responses we received we were told by some trusts that they had to suspend or restrict services in order to “maintain the safety of the ward” or “ensure safe care could continue to be provided.” But what was not considered in any of these responses was how women and birthing people’s sense of safety is impacted by blanket suspensions or restrictions which don’t take into account individual needs and experiences. In fact, we heard from some, that using safety as an excuse to withdraw access to services often has the opposite effect: 

Almost every week there is a headline exposing a maternity system in crisis. Birthrights hears daily from women and birthing people who have not felt safe in maternity care, too often experiencing trauma because of being ignored and dismissed, being faced with scaremongering and coercion, and a lack of personalised care. Staff too tell us they feel deskilled, disempowered, and demoralised by a system that doesn’t allow them to practise the kind of person-centred care they believe in. 

Under pressure and fearful of negligence claims that continue to be dominated by maternity cases, NHS Trusts are interpreting safety through a defensive lens. Risk assessment criteria can work to completely close off care options for women and birthing people simply because of factors such as their race, age, BMI and immigration status, without consideration of individual circumstances and with no opportunity for individuals to make informed decisions about their care. We see this clearly in the findings of our most recent report, which also demonstrates that as with much of maternity care, it is marginalised communities who are most impacted by restrictions. 

What does this mean for the way care is delivered?

The result? A system that focuses purely on narrow obstetric outcomes and fails to take account of the long-term physical and psychological harms that arise when women and birthing people are denied autonomy and agency. When process takes over, we are left with a system that only services itself. 

So, how do we begin to reverse the serious decline in maternal experiences in the UK and take real action to eliminate disparities in outcomes?