Shrewsbury hospital’s ‘overzealous’ pursuit of natural birth left patients at risk, critics say

As trust is revealed to have among nation’s lowest caesarean rates, mother who lost her baby asks: ‘How many other maternity units are putting ideology above safety?’

Critics say the figures may show staff at the hospital waited too long to step in (Alamy)

The hospital trust at the centre of the worst maternity scandal the NHS has seen stands accused of putting patients at risk with an “overzealous appetite” for natural births.

Shrewsbury and Telford Hospital Trust’s maternity wards, where dozens of babies and three mothers died, had the lowest caesarean rates in the health service, analysis by The Independent shows.

The wards ranked either bottom or within the bottom three for caesarean sections across the country between 2010-11 and 2017-18.

Critics pointed to the figures as signs that doctors and midwives may have waited too long to step in when either mother or baby was at risk during childbirth.

Watchdog the Care Quality Commission even praised the trust’s low rate of caesareans in an inspection report in 2017 as being better than targets, despite widespread debate at the time about the safety of midwives pursuing natural births.

In his report into the Morecambe Bay maternity scandal in 2015, Dr Bill Kirkup said midwives pursued “normal” births “at any cost” which he described as “inappropriate”, and which contributed to the poor care at the Cumbria hospital where 11 babies and one mother died.

The Royal College of Midwives abandoned its “normal birth” campaign and removed advice for midwives from its website in 2017 amid concerns it could be misleading.

Between 2010 and 2018, Shrewsbury and Telford (SATH) had a caesarean section rate of between 15 per cent and 22 per cent of births, compared with a national rate for England of 25 and 30 per cent.

The only other trust with as consistently low a rate of caesarean sections was the Mid-Staffordshire Foundation Trust, until it was dissolved after 2015 following a major care scandal there that led to a public inquiry in 2013.

Across the same period, Shrewsbury and Telford also had the highest natural, or spontaneous, birth rate, coming top in five of the eight years to 2018 and in the top three in the remaining years.

Between 2010 and 2018, the trust had a level of spontaneous births of between 67 and 73 per cent, compared with a range of 56 and 60 per cent nationally.

Peter Walsh, chief executive of the charity Action against Medical Accidents, which supports patients who have been harmed in healthcare, said he was concerned by what the data might suggest.

“Whilst every case needs to be looked at individually to know whether the treatment was appropriate or not, it may be no coincidence that SATH had one of the lowest caesarean rates in the country along with one of the highest rates for ‘spontaneous’ births,” he said.

“This coupled with the reported poor consent process for using midwife-led units may suggest an overzealous appetite for ‘natural’ births rather than doing what is safest for mother and baby, which can be a caesarean.

“This is a problem we have come across in other maternity settings.”

Rhiannon Davies, who has campaigned to expose poor maternity care at the trust after the avoidable death of her daughter Kate, in 2009, said: “The midwives and doctors are waiting too long to intervene because of this toxic culture that says birth is normal and medical help is failure.

“How many other maternity units are putting ideology above safety?”

In 2011, the Shrewsbury hospital issued a press release celebrating the fact its caesarean section rates were the lowest in the country, and telling local media the success was down to “having an environment which encourages natural childbirth and a wide range of strategies to keep caesarean deliveries low”.

The former head of midwifery, Cathy Smith, after receiving a written warning for her actions in relation to the death of Rhiannon Davies’ daughter, said: “We try and have a department-wide ethic of natural childbirth.”

The independent investigation into the Shropshire trust is now considering more than 600 alleged cases of poor care.

Adam Gornall, clinical director for maternity at the Shrewsbury trust, said: “Natural birth has benefits including being more likely to be able to breastfeed shortly after birth and having a shorter hospital stay. We do not put natural birth over intervention, but assess and escalate as necessary to safeguard or give best outcome for mothers and their babies. For example, our rates for induction of labour are higher than usual.

“Caesarean section is not without risks to the mother. When looking at the possibility of harm to mother or baby, national data does not demonstrate the lower c-section rate at SATH is associated with an increase in harm and, in fact, demonstrates a trend in the opposite direction.

“Over the past five years, there has been a steady increase in planned c-section rates at SATH.”

The CQC said in a statement: “Avoiding unnecessary intervention in any pregnancy, particularly low-risk pregnancies, is very important, but this should never be at the expense of a woman’s or baby’s health.

“It is absolutely not our view that trusts should be encouraged to reduce caesarean rates. Last year following a review of our inspection reports on maternity services we issued additional guidance to our inspection teams to ensure that going forward the wording used in our reports is clear, accurately reflects our position and does not appear to encourage one approach over another.”

Update: This article was updated at 4.30pm on 22 November to remove an inaccurate claim by the Shrewsbury and Telford Hospitals Trust that its emergency c-section rates were within normal limits, The Independent has verified that this is not in fact the case