Why do so many women experience birth trauma? Lawyer injured during childbirth gives evidence to the Parliamentary Inquiry that intends to find out

Research shows that 4-5% of women develop post-traumatic stress disorder after giving birth, equivalent to approximately 30,000 women every year. 

Serious physical injuries such as pelvic organ prolapse, perineal tears, pelvic pain and incontinence due to childbirth are also commonly reported. However, action is being taken on a national level to raise awareness and improve maternal safety.

National Birth Trauma Inquiry in UK Parliament 

When Theo Clarke MP stood up in the House of Commons in October 2023 to share her birth trauma story, it was a historic day. It was the first time in Parliament’s 1,000-year history that birth trauma had been debated. She gave an emotional and compelling speech in front of a packed public gallery. “It was definitely the most terrifying experience of my entire life,” Theo said. “ I thought I was going to die.”

As I listened to the debate in the public gallery many of the experiences Theo talked about resonated strongly with myself and the other women who attended. I sustained life-changing Obstetric Anal Sphincter Injuries (OASI) and Post-Natal PTSD following the traumatic birth of my first child, Maya, in 2008. 

The impact on my health, career and family has been profound and I still suffer with pudendal neuropathy and permanent bowel and urinary incontinence which affect me on a daily basis. 

I was therefore honoured to be asked to give live evidence yesterday at the National Birth Trauma Inquiry in my role as an expert in maternity care. 

The All-Party Parliamentary Group (APPG) on Birth Trauma that Theo Clarke chairs has set up the cross-party inquiry to hear evidence during a series of sessions between 5 February and 18 March, 2024. The inquiry has been gathering written submissions from parents and professionals to share their experiences of birth trauma in a formal way and to develop policy recommendations to reduce the rate of birth trauma. 

 The Inquiry will report in April 2024.

Background to the inquiry 

In July 2023 Theo Clarke MP bravely shared the story of the traumatic birth of her daughter during which she sustained a third-degree tear. She raised issues of poor post-natal care for mothers who had experienced birth trauma and disparity over access to perinatal mental health services. She also noted that the words ‘birth trauma’ appeared just once in the Women’s Health Strategy, and only as a mention. 

Theo invited responses from other mothers with similar experiences and subsequently set up the All-Party Parliamentary Group (APPG) on Birth Trauma with her co-chair Rosie Duffield MP. 

I attended the inaugural meeting on 11 September, 2023, together with representatives from the Royal College of Obstetricians and Gynaecologists, Birth Trauma Association, The MASIC Foundation, Make Birth Better and the Maternal Mental Health Alliance. At this meeting Theo announced the shocking results of a birth trauma survey undertaken with Mumsnet of over 1,000 women.

Birth trauma: the statistics

The key findings of the survey were that the majority of women - 79% - experience some form of birth trauma.

Other notable findings included:

• 53% of women advised they experienced physical trauma
• 71% experienced psychological or emotional trauma
• 84% of women who experienced tearing said they didn't receive enough information about birth injuries ahead of time
• 43% women felt unsafe during their birth experience 
• 19% of women weren't offered a six-week check by their GP
• 62% would describe the mental health care and advice they received from healthcare professional in the weeks after birth as poor or very poor
• 53% of women who experienced birth trauma are less likely to have children in the future.

Measures aimed at improving care for mums to be introduced  

Following the first Parliamentary debate on birth trauma where Theo and other MPs shared their lived experience and that of their constituents, Maria Caulfield MP, Minister for the Women’s Health Strategy announced the following measures:

• Implementation of the OASI (obstetric anal sphincter injury) care bundle across England to reduce the rates of severe perineal tears and help manage such injuries better when they do occur, and;
• Implementation of a National Pelvic Health Service to improve access to early intervention and support for women experiencing symptoms of pelvic floor dysfunction.

The Birth Trauma Inquiry's objectives 

At the heart of the inquiry are the lived experience of mothers, fathers, trans and non-binary parents, and birthing partners who have experienced or witnessed a traumatic birth. 

The objectives are to: 

1. Identify common features in maternity care (ante-natally, during labour and birth, and post-natally) that contribute to birth trauma.
2. Highlight examples of good practice, both in the quality of maternity care and in providing support to women who have had traumatic birth experiences. 
3. Look at the impact of birth trauma on women’s relationships, their ability to bond with their baby and future decision-making (e.g. whether to have another baby, whether to return to work). 
4. Find out whether current postnatal services to diagnose and treat women’s physical and mental health problems are up to scratch. This would include, for example, looking at whether severe obstetric tears are being diagnosed promptly, whether mental health problems are being identified at the six-to- eight-week check, and whether perinatal mental health teams are accepting and treating women within an appropriate time frame. 
5. Develop parameters for understanding the possible economic cost of birth trauma, with a view to informing future research. 
6. Influence government policy by identifying areas where maternity care could be improved to minimise birth trauma and by highlighting ways in which postnatal support can be optimised to meet women’s physical and psychological needs after traumatic birth.

Common maternity care features that can contribute to birth trauma injuries in women

Drawing on the first objective of the inquiry, as a firm with a particular expertise in birth injury cases we at Irwin Mitchell often encounter the same themes time after time. 

We hear from a range of women who often felt they weren't listened to and didn't receive compassionate care. We also hear from a disproportionate number of women of ethnic minority origin who have had these adverse experiences and outcomes. 

Within my roles at both The MASIC Foundation and Birth Trauma Association, both members of the Special Advisory Group to the inquiry, I also hear common themes from many women around lack of ante-natal information, issues around informed consent and poor post-natal support for both psychological and often physical injuries. 

Health Inequalities in maternity care 

It's significant that the inquiry is particularly welcoming submissions from people from marginalised communities such as those who are racially minoritised, LGBT, economically disadvantaged, homeless, asylum seeking or displaced, care experienced, neurodivergent or facing any other circumstance which means their voice is less likely to be heard.

The latest MBRRACE – UK report continues to show poor outcomes for new mothers, and that more needs to be done to reduce maternal deaths and end maternal health inequalities particularly for black and ethnic minority groups. The inequalities that were identified in data between white, Asian and black mothers also extended to people living in the most deprived areas which was double the least deprived areas. 

As a South Asian woman who sustained an OASI I only became aware years later, and through my own research, that I was at six times greater risk of suffering a third or fourth-degree tear. Within certain communities there's also a recognised stigma associated with talking about bowel incontinence, birth injuries and stomas which can make the impact of these injuries even greater.

Women’s Health Strategy 

The APPG on Birth Trauma has already achieved one its main ambitions, the inclusion of Birth Trauma within the women’s health strategy. In January 2024, Victoria Atkins Secretary of State for Health and Social Care also announced:

• Specialist maternal mental health services rolled out across England by March 
• An eight-week post-birth check up with a GP, focused solely on the a mum’s mental and physical health
• Expansion of Women’s Health Hubs across England.
• The launch of 14 Maternal Medicine Networks across England to ensure that women with medical conditions that pre-date or develop during pregnancy will receive specialist care.

Other measures in the strategy included a Maternity Safety Support Programme to give underperforming Health Trusts assistance before serious safety issues arise. This is particularly significant given that half of the Care Quality Commission’s recent series of inspections are rated either “inadequate” or “requiring improvement.”  

Medical negligence lawyer helps inform health policy to improve patient care

I felt privileged to attend Parliament to provide practical recommendations to inform the policy report for the UK Government and to act as a voice for other women who have gone through these devastating experiences. 

It was emotional at times reliving the injuries both myself and my daughter sustained, but it was also powerful to be part of such a strong collaboration of experts, charities and politicians working towards reducing birth trauma, whether physical or psychological. 

I look forward to continuing the work of the APPG on Birth Trauma with our charity partners, The MASIC Foundation, Make Birth Better and the Birth Trauma Association to create positive, meaningful and practical change in maternity care. 

Find out more about Irwin Mitchell's expertise in supporting people affected by issues in maternity care at our dedicated birth injuries section.