Hospitals continue to promote ‘normal’ births despite NHS guidelines

NHS hospitals continue to advertise midwife jobs that will promote ‘normal birth’ despite official guidance, AND learned.

After a series of safety scandals, including preventable maternal and infant deaths, hospitals were ordered two years ago to stop promoting “normal” births — a term meaning natural births without medical assistance — in a bid to reduce the number of cesarean sections.

But AND has seen eight adverts placed in 2024, some this month, that include statements suggesting midwives will be required to “promote normal birth” or “physiological birth”. The terms “normal”, “physiological” and “natural” birth are generally used interchangeably to mean natural childbirth without any medical assistance.

In 2022, NHS England advised all hospitals not to discourage women from having a caesarean section in a bid to increase the number of natural births, and official guidance says women have the right to choose a caesarean section even if there is no medical reason to do so.

A cesarean section can be life-saving if the baby gets stuck during labor. That said, it can also take longer to recover and increase the risk of infection and complications in later pregnancies, studies have shown.

When you get closer AND, Some hospital boards have said they will change the language used in future adverts. For example, the Royal Free London Hospital ran an advert for a midwife, which closed this month, saying its “main aim is ‘normality in midwifery'”.

A spokesman said the phrase was used in error. “This phrase will not be included in future job advertisements,” the spokesman said.

“Keeping women and their babies safe is the absolute priority of all staff working in our maternity unit.”

Other adverts seeking midwives promoting “normal” or normal births have been placed this year by Bedfordshire Hospitals, Medway NHS Trust, Calderdale and Huddersfield NHS Trust, Walsall Healthcare, Maidstone and Tunbridge Wells NHS Trust, Worcestershire Acute Hospitals and North Middlesex University Hospitals.

Bedfordshire Hospitals and Maidstone and Tunbridge Wells NHS Trust said they would change future job adverts. Walsall Healthcare and Worcestershire Acute Hospitals said safety was a priority. The other three hospitals declined to comment or did not respond to emails.

The findings come after the publication this month of a damning report into the NHS by former Labour health minister Lord Darzi, which found maternity care to be particularly poor, citing evidence of different healthcare staff having “divergent curricula”.

The investigator who provided this evidence, Dr. Bill Kirkup, has now said AND that this refers to the fact that part of the staff training focuses on promoting “normal” births.

What are “normal” births?

The terms “normal”, “natural”, and “physiological” are often used interchangeably to describe vaginal birth without medical intervention.

A birth wouldn’t be classed as “normal” if a woman had an epidural for pain relief, where strong drugs are administered into the back. However, most would still consider it a “normal” birth if the milder painkiller of gas and air was given.

Even if some sort of instrument, such as forceps, is used to extract the baby, it is usually not considered a “normal” birth.

While other failings included insensitive care and a lack of investigations into deaths, “the promotion of physiological birth regardless of risk was a consistent finding in serious inquiries into failed maternity services,” said Dr Kirkup, who has conducted two such inquiries himself.

The Royal College of Midwives (RCM) did not respond to a request for comment for this article. However, in response to another critical report on maternity services published this week by the Care Quality Commission, Gill Walton of the RCM said hospitals had “too few staff with the right training, too little time to care for and listen to women, and a crumbling infrastructure”.

However, Darzi’s latest report on the NHS in the UK found that as staffing levels rose and births fell, the number of births per midwife per year had fallen from 35 in 2007 to 26 in 2022.

However, the Darzi report confirmed that the medical needs of women during childbirth had increased during this period, due to factors such as advanced maternal age and the greater number of obese and diabetic women.

An NHS spokesman said: “The NHS has a duty to provide women and families with safe and personalised care that is in line with best practice guidelines and is evidence-based, and it is a fundamental requirement for maternity teams to inform and listen to every woman, respect her views and help her achieve the type of birth she would like.”

A Department of Health and Social Care spokesman said: “Women need to know that their wishes are respected and listened to during labour and it is unacceptable that too many women do not receive the maternity care they deserve.”