A woman and newborn baby together shortly after a caesarean birth

“Terrified”.

“Shame”.

“Humiliation”.

“Broken”.

A new report published today/this week by a group of UK parliamentarians has given a voice to many women who have experienced trauma while giving birth, highlighting much needed improvements to ensure expectant mothers are treated with dignity and compassion.

Women who responded to the report frequently used the words “terrified”, “humiliation” and “broken” when describing their experiences, and the report paints a stark picture about women not being listened to or believed during childbirth, not communicated to, and not having informed consent about treatment.

Here at the University of Birmingham, we are conducting research to understand key aspects of the childbirth journey that have been highlighted in the new report.

The women we have been working with have echoed many of the sentiments expressed in the Birth Trauma report.

Physical trauma

8 in 10 women who give birth vaginally experience perineal tearing.

What’s more, the report suggests that the number experiencing third and fourth degree tears, which have a huge human cost for mothers including incontinence and organ prolapse, is underreported and may be as high as 10%. It also has a major financial cost with £1.1bn in legal damages being paid out in 2022/23.

The University of Birmingham is currently carrying out a clinical study called CHAPTER to help improve care for women with perineal trauma.

The Chapter Study programme involves four interlinked work packages working closely with women and public groups, which involves:

  • Summarising existing research and good practice worldwide
  • Carrying out research using existing information to understand how frequent and serious any complications are
  • Develop and testing a tool to assess CRPT and help direct care more effectively
  • Working with mothers and healthcare professionals to understand their views on what is important to them, how a perineal wound assessment tool might be used and how any treatment should be delivered.

The women we have been working with have echoed many of the sentiments expressed in the Birth Trauma report too, where perineal trauma is not treated effectively and leads to physical as well as psychological problems.

We will be reporting from the CHAPTER trial in 2026, and we will be making recommendations that focus on the need for use of the common assessment tool developed and women centred treatment pathway for all perineal trauma, especially the third and fourth-degree tearing that the report highlights.

Inequalities

The report also recommends that a Maternity Commissioner should be appointed and should commit to tackling inequalities in maternity care among ethnic minorities.

Our own research in 2022 highlights that babies born to black mothers are twice as likely to die in richer countries around the world. This is not an issue solely for the UK, but we must accept that there are systematic issues in our healthcare that are leading to a deeply distressing disparity in maternity care where many more ethnic minority mothers and babies are dying.

We are also carrying out research to better understand and address this issue including studies carried out in the West Midlands, one of the most diverse parts of the country where more than 50% of residents are from a minority ethnicity. As a founding member of Birmingham Health Partners and with other universities in the West Midlands, we are ideally placed to carry out clinical research with our partners in NHS Trusts to identify, trial and evaluate ways to ensure maternity healthcare is equally available for every mum.

Research includes the Midlands Patient Safety Research Collaboration, which will be focusing on the use of digital healthcare platforms to objectively assess and spot risks for expectant mothers.

A vision for ‘good’

As researchers, we read this latest APPG report reflecting on the sad reality for many women in the UK and across the world who don’t experience ‘good’ care during childbirth.

We are also heartened to read about a vision for “what… good look[s] like in maternity”.

We are heartened because this vision aligns with our own vision and values for seeing maternal healthcare that is shaped by the best evidence and guided by women’s voices. From improving the access to medicines tested for women during pregnancy to highlighting the healthcare ‘postcode’ lottery for survivors of FGM, we are championing access to dignified, fair and evidence-based healthcare for all expectant mums.

Read more about Women’s Health at the University of Birmingham.

By Professor R. Katie Morris, Professor of Obstetrics and Maternal Fetal Medicine,
Dr Victoria Hodgetts Morton, NIHR Clinical Lecturer in Obstetrics and Gynaecology, and
Dr John Allotey, Associate Professor in Epidemiology and Women’s Health