What Louise Thompson’s campaign tells us about the national maternity crisis

Frances Hand is a DPhil Candidate in the University of Oxford’s Faculty of Law. She has spoken at the Mexican Supreme Court and the Royal College of Obstetrics and Gynaecology World Congress about the impact of childbirth experiences on women in NHS maternity wards. Here she reflects on the campaign by TV star Louise Thompson to appoint a UK Maternity Commissioner and what this could mean for the thousands of women who give birth in the NHS every year.

A new Maternity Commissioner?

On average, a woman gives birth in the UK every 56 seconds - many for the first time. In 2021, one of these women was Louise Thompson, a reality TV star best known for appearing in Made in Chelsea. Thompson has spoken extensively about her traumatic birth experience and the serious, life-changing complications that she continues to suffer with. Last month, Thompson launched a campaign, alongside former Conservative MP and chair of the first parliamentary inquiry into birth trauma, Theo Clarke, petitioning the government to appoint a Maternity Commissioner.

A Maternity Commissioner would play a vital strategic role in improving maternity care in the UK. They would oversee maternity and neonatal services, work to improve safety and quality of care, and manage important budget decisions. Advocates suggest that a Maternity Commissioner would help restore public confidence in NHS maternity services and ensure accountability.

Frances Hand - Faculty of Law

The national birth trauma crisis

While Louise Thompson is the headline name of the campaign, she is just one of the thousands of women who are part of what can now be described as a national maternity crisis. One in three women in the UK describe their childbirth experience as ‘traumatic,’ with approximately 4% (or 30,000 women) developing postnatal PTSD annually as a consequence. Moreover, maternal mortality has risen by 20%, rather than reduced, over the past 15 years.

Women describe a broad range of harms that they have experienced, including not being listened to, being convinced to give birth in a manner that they didn’t want or believe was necessary, being asked for consent in ways that make true choice difficult, being shamed or laughed at, and being abandoned.

These harms can have lasting and long-term emotional and psychological ramifications for women and birthing people, including impacts on relationships between all family members and the making of future healthcare decisions. As Thompson highlights from her own birth experience: 'I had no relationship with my son for the first year, year and a half.'

During my doctoral research, a number of national and regional reports have been published detailing thousands of stories of harm experienced by women in NHS maternity wards. This not only underlines the sheer scale of the problem, but the timeliness of this research. The reports produced from these testimonies, however, have been criticised for framing the issues as isolated incidents of a ‘lack of kindness’, or attributing the harms to poorly performing individuals or NHS trusts, rather than identifying the overarching themes that unite these narratives. This risks hiding a much bigger story. Theo Clarke recently told Good Morning Britain that there are more than 700 policy recommendations yet to be implemented from previous reports. My doctorate aims to create a national picture of this crisis, demonstrating that these are not one-off incidents but reflect far deeper issues embedded within maternity care - and more broadly related to how society treats women.

Implications for international human rights law

Many of the causes and consequences of maternity harms in the UK that I have identified within my doctoral work align closely with global conversations on ‘obstetric violence’. Originating in Latin America, this terminology has gained global recognition as a more nuanced and accurate way of describing maternity harms. Obstetric violence is useful because it places maternity harms within the broader continuum of violence against women, showing how these harms replicate and uphold traditional attitudes about women as mothers and wives.

Equally, this terminology is crucial in clarifying that the issues experienced are a result of obstetrics - the medical discipline, culture and healthcare system - rather than necessarily the individual practitioners. Framed in this way, obstetric violence is also understood as a term with human rights implications, as demonstrated by the UN Special Rapporteur 2019 report on a human rights-based approach to mistreatment and obstetric violence during childbirth. Experiences of obstetric violence violate a broad range of rights, such as freedom from discrimination, right to privacy and bodily integrity, and freedom from inhumane treatment and torture. This framework offers a new way of understanding the harms experienced in the UK - not as a series of isolated failings in individual care, but as symptoms of a broader systemic problem with legal, social and educational dimensions.

To date, governmental enquiries have been reluctant to characterise the maternity crisis in the language of obstetric violence. Critics of this approach have highlighted how the national birth trauma inquiry report suggested that while lessons could be learned from other countries where ‘obstetric violence’ was explicitly recognised, harms in the UK were instead described as a ‘lack of kindness’ or ‘lack of compassion’, minimising their severity. My research suggests that this attitude is hampering the ability of the UK to reform. By avoiding the language of gender-based violence and human rights, the UK limits the applicability of international human rights law and its obligations to take positive steps to protect women from harm. The proposal to appoint a Maternity Commissioner is one example of an important strategy to reduce the structural harms inherent within the NHS. Yet, it is unlikely that this will be acted upon when the harms continue to be framed as interpersonal.

What’s next?

At the time of writing, Thompson and Clarke’s government petition sits at more than 140,000 signatures - well over the 100,000 required to trigger a parliamentary debate. The government responded last month, suggesting that there are currently no plans to appoint a Maternity Commissioner, but that it had commissioned an independent investigation into maternity and neonatal care, which would make its recommendations in spring of this year.

While it is commendable that the government continues to investigate maternity care as a national issue, the 700 previous recommendations that are still to be enacted suggests it is time for action rather than further investigation. Likewise, there is a risk that these inquiries may only be highlighting further symptoms instead of identifying and responding to the causes of these harms.

Louise Thompson’s story is painful to read, and yet it is merely the headline of a much wider crisis - a crisis that will continue to impact thousands of women in the years to come without a significant change of strategy.