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Harrowing accounts of birth trauma lead to MPs’ call for concerted action to improve maternity services

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1084 (Published 14 May 2024) Cite this as: BMJ 2024;385:q1084

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Re: Harrowing accounts of birth trauma lead to MPs’ call for concerted action to improve maternity services

Dear Editor

All healthcare professionals involved in maternity care should be shocked, but may not be surprised, by the report of the All-Party Parliamentary Group on Birth Trauma (1). It is concerning that after multiple reports (2), policy change and investment, so many women and families have such profoundly distressing experiences.

GPs are now often deskilled and/or untrained in routine maternity care, but every MBRRACE report into maternal deaths demonstrates they are frequently involved in the perinatal journey, especially for the most complex women (3). The deaths are the tip of an iceberg of physical and psychological perinatal morbidity that conceals terrible trauma for families.

Most perinatal maternal deaths occur postnatally. The time when women and partners need support for birth trauma is postnatally, yet postnatal care is fragmented, with many multidisciplinary professionals involved, but no effective leadership. We were therefore surprised that this inquiry did not take oral evidence from GPs or Health Visitors, when these are the professionals to whom women and families often turn.

In recent decades, GPs have been poorly represented in maternity policy, yet GPs see themselves as having a key role in the clinical care of women—and their families—in the postnatal period (4). They do and should play an important role in identifying and supporting people who experience or are affected by birth trauma and baby loss. Not to include GPs at the table, not to understand what they are currently doing against the odds, not to train them for this job, will perpetuate this fragmented system.

GPs Championing Perinatal Care (GPCPC) is a network of UK GPs collaborating to improve perinatal care in primary care. We submitted written evidence to the review and hope work to address the report’s important recommendations actively includes GPs and Health Visitors as key stakeholders to improve perinatal care.

References
1. All Party Parliamentary Group on Birth Trauma. Listen to mums: ending the postcode lottery on perinatal care. May 2024. www.theo-clarke.org.uk/sites/www.theo-clarke.org.uk/files/2024-05/Birth%...
2. Shakespeare J, Duff E, Beck D. How many more reviews are needed? Joined-up policy and investment in England's maternity units is needed now to improve postnatal and inter-pregnancy care. Midwifery 2022. https://doi.org/10.1016/j.midw.2022.103469
3. Knight M, Bunch K, Felker A, Patel R, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Core Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2023.https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-r...
4. Macdonald C, MacGregor B, Hillman S, et al. Qualitative systematic review of general practitioners’ (GPs’) views and experiences of providing postnatal care. BMJ Open 2023;13:e070005. doi:10.1136/ bmjopen-2022-070005

Competing interests: No competing interests

21 May 2024
Judy Shakespeare
Retired GP
Deputy Chair of GPCPC
Oxford