Baby Loss and Safe Staffing in Maternity Care

Guy Opperman Excerpts

Tuesday 25th October 2022 Westminster Hall

[Jill Mortimer]

He was a whopper; he still is a whopper. It caused long-term damage to my pelvis but, worse, he has had to battle his entire life with learning difficulties caused by a lack of oxygen at his birth. He was a floppy, quiet baby, and at 18 months he was diagnosed with, among other things, hypertonia. All his development was delayed, and he did not walk or speak until he was nearly two. I worked with him, and I am so proud that he kept battling on learning how to learn. Today, at 27 years old, he is training to be a nurse. [Hon. Members: “Hear, hear!”]

It was only during my third pregnancy that I experienced continuity of care, which was wonderful. The ability to build a relationship with my midwife, who stayed with me throughout my pregnancy, labour and beyond, was invaluable. I did not have to go through my story with new people all the time and had someone I came to know and trust by my side. I was lucky enough to experience that and wish more women had that chance.

Despite the benefits of continuity of care, I look back on the pregnancy and birth of my daughter with mixed emotions, because there should have been two of them. Very early in that pregnancy I again started to bleed. I bled with my first son and ended up spending a week in hospital, with people saying to me, “Don’t worry, it’s very early on; you’ll have another baby.” I lay still for a week, I did not breathe, and I kept him. But this time I started to bleed again, and I miscarried my daughter’s twin. I did not know how to feel or how to grieve, while having to put all my efforts into sustaining my pregnancy, fearful every day that I would lose the baby I still carried. I was lucky that my beautiful daughter was born safe and healthy, but that loss never goes away. With each milestone, I reflect on how they should be celebrating together. There should be two of them.

[Guy Opperman (Hexham) (Con)]

Grab a breath for a second. First, I congratulate my hon. Friend on bringing forward this vital debate. The House is joined with her in supporting the cause that she is espousing. Does she agree with me—this is something that I certainly have suffered from—that the concept of the take-home child is something we all need to come to terms with? I have had three children, but I have been able to take only one home. For my hon. Friend, it is unquestionably the case that she loves and adores her daughter, but never forgets those who came along with her but did not make it in the end. Is that a fair description of the situation?

[Jill Mortimer]

It is, Guy. Now you have made me feel more upset.

[Guy Opperman]

I was trying to help!

[Jill Mortimer]

You have done. Yes, that loss never goes away. I still feel guilty, because it was so early; I did not go through what people such as my hon. Friend have gone through.

--- Later in debate ---

[Guy Opperman (Hexham) (Con)]

I thank my hon. Friend the Member for Hartlepool (Jill Mortimer) for bringing forward this debate. This is my first Westminster Hall speech in seven and half years; it is an honour and a privilege to speak on such an important matter.

I have had three children, but was able to take only one home from hospital. Teddy and Rafe came and went in the summer of 2020—briefly—and were loved all too shortly. I welcome the work led by the teams at Oxford and Leicester to ensure that there is clear advice to support health professionals in assessing and documenting signs of life in extremely difficult pre-term births. That is what I want to focus on.

I should put on the record, as I am sure many will, the amazing charities such as Sands and others who work in this sphere and who have helped me get over the trauma, loss and bereavement, as have the Northumbria NHS trust in my constituency and St Thomas’s, where my children were born. I thank my constituent, Sarah Richardson, and all the teams at Hexham Queen’s Hall and Hexham Abbey for their support for baby loss awareness.

Consistency across the NHS is key. People will lose children; that is a fact of life. Pregnancy is, as we all discover, more complicated than we imagined it would be—even in 2022. There is work to be done on the improvement of midwives and maternity staffing levels, but the key for me is a consistent approach across all NHS trusts up and down the country. Why does that matter? Because there should not be a postcode lottery in which a parent in trust A is treated differently from a parent in trust B, and poor souls go on the internet and find out that in trust A they would have been treated in one way, but in trust B in another way.

We all have to accept that mistakes are made and that giving birth is a fragile process, but we should expect the NHS and our Government to promote consistency of approach in dealing with the individual issues that mums and dads have.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Does the hon. Member agree with me that the principle that he correctly outlines should also apply to the nations of the United Kingdom, and that equality of service should apply right across Great Britain?

[Guy Opperman]

It is a perfectly fair point that there is a difference of approach in the different countries of the great United Kingdom, and I utterly agree that if someone lives in the United Kingdom, they should have a consistency of approach. There should be a coming together of the various professional boards to drive forward consistent standards. I will give one specific example.

[Alicia Kearns]

Will my hon. Friend give way?

[Guy Opperman]

My hon. Friend will take my time, but I will give way very briefly.

[Alicia Kearns]

Before it even gets to treatment, a big problem is the way we assess the safety of a pregnancy, which is the same as it was in the 1960s. It has not changed. There is a new AI programme—the Tommy’s app—that could be rolled out across the entire country to ensure that technology is used to assess the vulnerability of pregnancies. Does my hon. Friend agree that that sort of tool is what we need rolled out to ensure consistency of diagnosis and safety in pregnancy, and not just treatment?

--- Later in debate ---

[Guy Opperman]

I endorse what my hon. Friend says. It helps doctors. Doctors and midwives are not the villains here; they all try very, very hard. It is easy for politicians to say, “This trust is not doing the right thing,” or, “This team is not doing the right thing,” but that is genuinely unfair. We have to shy away from being so critical.

This is about trying to provide the cover and approach so that clinicians are better able to deal with particular scenarios and situations. That is genuinely possible. There is good evidence that, on occasion, parents have been told that their child was stillborn when it should have been determined to be a neonatal death. That has consequences, because, as some will know, coroners can investigate neonatal deaths but not stillbirths. There is some evidence—only some; this is very much anecdotal and I do not want to start hares running—that a trust seeking to improve its figures would say that more births were stillbirths rather than neonatal deaths.

We have to be honest about the process and start from a position of generosity of spirit towards the doctors and clinicians who all try their hardest. If nothing else emerges out of today, driving forward a consistency of standards on how deaths are treated is vital.

I have one final comment. My second child came and went in one very long day at St Thomas’s, over the road from this place. The fact that his was a neonatal death meant that the trust attempted to save his life for a period of time and we were able to spend time with him, which is something that I will always treasure.

--- Later in debate ---

[Dr Johnson]

I will not, because I have a lot of questions to get through in a really short time.

Many hon. Members talked about bereavement. In the difficult scenario of baby loss, we understand that bereavement care for women and families is critical. We continue to engage closely with the bereavement sector to assess what is needed to ensure that bereaved families and individuals receive the support that they need. This year we have provided £2.26 million of national funding to support trusts, expand the number of staff trained in bereavement care and directly support trusts to increase the number of days of specialist bereavement provision that families can access.

In the women’s health strategy, which hon. Members mentioned, published earlier this year, we discussed the introduction of pregnancy loss certificates for England. This will allow a non-statutory, voluntary scheme to enable parents who have experienced a pre-24 weeks pregnancy loss to record and receive a certificate to provide recognition of their baby’s potential life. The certificate will not be a legal document, but it will be an important acknowledgement of a life lost, and we hope that it will provide comfort and support by validating a loss.

We understand the impact of pregnancy and childbirth on mental health, especially for those affected by the loss of a baby, and we are committed to expanding and transforming our mental health services so that people can receive the support that they need when they need it.

As part of the NHS long-term plan, we are looking to improve the access to and quality of perinatal mental health care for mothers and their partners. Mental health services around England are being expanded to include new mental health hubs for new, expectant, or bereaved mothers. These will offer physical health checks and psychological therapy in one building.

[Guy Opperman]

I accept that my hon. Friend has many things to cover today. As a former Minister, may I advise her that she might want to be encouraged to write to everyone with detailed answers from civil servants to the points raised?

Does my hon. Friend agree on one key point—that the collation of data and the consistency of approach must be nationwide? While we have many wonderful trusts, that has to be driven by the NHS, for which she is a Minister.

[Dr Johnson]

I absolutely agree with my hon. Friend.

Going back to the issue of perinatal mental health, we have previously funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce and support the roll-out of a national bereavement care pathway to reduce the variation in the quality of bereavement care provided by the NHS and ensure that, wherever a woman and family are being cared for, they get a high standard of care. The pathway covers a range of circumstances of baby loss, including miscarriage. As of April this year, 78% of trusts in England had committed to adopting the nine national bereavement care pathway standards.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) talked about pre-eclampsia. NHS England is establishing maternal medicine clinics. These are specialist networks across the UK, which will manage pre-conception, antenatal, post-natal and medical issues in women, and reduce long-term morbidity, thereby improving outcomes for those women who have co-existing medical conditions.

My hon. Friend the Member for Macclesfield (David Rutley) spoke about the maternity unit in his constituency. I know that he is a doughty campaigner for that unit. I will write to him with further information on progress in that area.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) talked about the Scottish health service and how it is performing in relation to maternity care. It is, of course, a devolved issue in Scotland, but I was moved to hear about what is happening in areas of the north of Scotland near Elgin. I would encourage the devolved Scottish Administration to consider carefully what is going on there and to see what they can do to improve care. It seems unacceptable for women to travel 102 miles to give birth.

The NHS in England has a medical education reform programme, co-sponsored by NHS England and Health Education England, to direct investment for specialty training for population needs back towards smaller and rural hospitals. That programme entered its implementation phase in August 2022.

Hon. Friends mentioned The Lancet recommendations. While the pregnancy loss review will be published shortly, I am not in a position today to commit to what it is going to say, but we will consider it carefully.