Tuesday, October 26

No Evidence and Little Research: No wonder women and babies keep dying | Sonia Sodha


GRAMGiving birth used to be one of the most dangerous things a woman could do. In parts of 15th century Europe, women wrote wills as soon as they found out they were pregnant. In the seventeenth and eighteenth centuries, around one in 25 the women died in childbirth. It was a danger that ran through all classes, from queens to housekeepers, and that women had to face over and over again. For their babies, the risks were even greater.

It is a miracle of modern medicine that the joy of getting pregnant no longer has to be tempered with the very real prospect that you or your baby may not survive birth. A true indicator of human progress is the fact that maternal and infant mortality has dropped dramatically in the UK, even as births have gotten more complicated, babies grow older and women have children later.

But in recent years, horror stories have surfaced of women and babies suffering terrible maternity care in various NHS trusts. Bereaved parents and spouses have struggled to be heard in the face of a culture of cover-up and medical professionals who blame mothers for the death of their babies. First, there was the investigation into the deaths of babies in the Morecambe Bay Foundation Trust, which emerged as a result of the tireless campaign of James Titcombe, whose baby died in his care. It found that a “lethal mix” of failures caused the preventable deaths of at least 11 babies and one mother. Last year, an interim report was published on the deaths of babies and mothers in Shrewsbury and Telford; Covering more than 1,800 cases over 20 years, it is one of the largest scandals in the history of the NHS.

He described how babies and mothers died unnecessarily or were left with profound disabilities as a result of terrible care; the babies suffered fatal skull fractures when they were forced out with forceps, and the women stood screaming in agony for hours as doctors belittled their pain and told them they were “lazy.” An investigation into the infant deaths in East Kent is currently underway, and last week the Independent reported that dozens of babies had died or suffered brain damage in University of Nottingham Hospitals NHS Trust.

The vast majority of mothers and babies will experience good maternity care in the UK. But this crop of scandals shows that there is a systemic problem with the quality of NHS maternity care, with the result that too many mothers and babies lose their lives. More than 1,000 babies they die or are seriously injured every year as a result of something going wrong during labor. It goes beyond the current underfunding crisis: the Quality of Care Commission has found that four out of 10 maternity services require improvement or are inadequate. Women of color are disproportionately affected: Black women are four times more likely to die in pregnancy or childbirth than white women.

Two deeply ingrained cultural factors are holding back maternity care. First, it has been increasingly documented that women are disproportionately disbelieving when they say they have pain, because there is a perception that we are hypersensitive to pain, or we exaggerate it. This is undoubtedly a factor in the poor quality of health care for women.

Second, women’s health care is under-researched and under-evidenced. This is true for conditions that affect both men and women: Diagnosis and care for women who have strokes and heart attacks are poorer because research has male centered – as well as things only women experience, like the debilitating pain of endometriosis. Research from last week showed that women continue to struggle to access treatment for menopause– Only 37% of women seeking help received HRT despite Nice guidelines stating that most women can benefit from it.

When it comes to childbirth, this predisposition not to believe in suffering women and to underestimate their medical needs has been particularly toxic, allowing an ideology to take hold that so-called normal, non-medicalized delivery is the best, regardless of what what a woman thinks or thinks. feel. Until a few years ago, this was widely accepted by the establishment: a task force that included the National Childbirth Trust, the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynecologists, advocated “normal birth”Without medical interventions like an epidural or caesarean section.

This has undoubtedly been a factor in which women and babies were denied life-saving care: in Morecambe Bay, midwives sought non-medical deliveries “at any cost”, intimidating doctors who tried to intervene. At Shrewsbury and Telford, there was a multiprofessional focus on “normal birth” in “almost any cost”.

The best type of delivery is obviously a delivery that delivers a baby safely, leaving the mother unharmed. For many women, that will involve an epidural or a C-section. Terms like “normal birth” are stigmatizing and shameful. But while the RCM formally abandoned this language in 2017, it remains in force in some parts of the midwifery profession. There are still midwifery conferences promoting “normal birth”. The University of Central Lancashire, a leading midwifery training center, still runs a course on “normal birth”. And a former president of the RCM presented last year evidence to a select committee that affirmed that women were not allowed the luxury that dogs and cats have of “going to a quiet place and continuing with the process”, and defended the reduction of obstetric standards in the delivery rooms .

Failures in maternity care are not just due to lack of staff and funding: they are linked to a deeply ingrained social perception that women should not be entrusted with their own bodies or not allowed to make their own. informed decisions about childbirth. How much more evidence do we need that institutionalized sexism at the heart of our healthcare system has cost women and babies their lives?

Sonia Sodha is a columnist for Observer


www.theguardian.com

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