NHS hospitals are continuing to advertise jobs seeking midwives who will promote “normal births” despite official guidance, i has learned.
After a series of safety scandals involving avoidable deaths of mothers and babies, hospitals were ordered two years ago to stop promoting “normal” births – a term for vaginal births without medical assistance – in the pursuit of bringing down caesarean section rates.
But i has seen eight adverts placed in 2024, some as recently as this month, that include statements suggesting midwives will be expected to “promote normal births” or “physiological births”. The terms “normal”, “physiological” and “natural” birth are generally used interchangeably to mean a vaginal birth without any medical assistance.
In 2022, NHS England told all hospitals not to put women off having Caesarean sections to boost their rates of vaginal births, and official guidelines say women have a right to choose Caesareans even if they have no medical need.
Caesareans can be life-saving if the baby gets stuck during labour. That being said, they can also can take longer to recover from, and raise the risk of infections and complications in later pregnancies, research has shown.
When approached by i, some of the hospital trusts said that they would change the language used in future adverts. The Royal Free London Hospital, for instance, placed an advert for a midwife that closed this month that said “‘normality in midwifery’ is the main focus”.
A spokesperson said the phrase had been used in error. “The phrase will not be included in future vacancy adverts,” the spokesperson said.
“Ensuring the safety of women and their babies is the absolute priority of all the staff working in our maternity services.”
Other adverts, similarly seeking midwives to promote “normal” or physiological births, were 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 the main priority. The other three hospitals either declined to comment or did not reply to emails.
The findings come after a damning report on the NHS this month by former Labour health minister Lord Darzi said maternity services were particularly bad, citing evidence that different healthcare staff have “divergent curricula”.
The investigator who provided that evidence, Dr Bill Kirkup, has now told i that this refers to the fact that some staff training focuses on promoting “normal” births.
What are “normal” births?
The terms normal, natural and physiological births are often used interchangeably to mean a vaginal birth without medical interventions.
A birth would not be classed as “normal” if the woman had an epidural for pain relief, where strong drugs are delivered into the back. But most would still consider it a “normal” birth if the milder painkiller of gas and air is given.
If any instruments are used, such as forceps to pull out the baby, this also would not usually be considered a “normal” birth.
While other failings included uncompassionate care and failures to investigate deaths, “promoting physiological birth regardless of risk has been a consistent finding in major investigations into failed maternity services,” said Dr Kirkup, who carried out two such investigations himself.
The Royal College of Midwives (RCM) did not respond to a request for comment for this article. But in response to a further critical report on maternity services out this week from the Care Quality Commission, the RCM’s Gill Walton said hospitals had “too few staff with the right training, too little time to care for and listen to women, and crumbling infrastructure”.
Yet the latest Darzi report on the NHS found that as staff numbers have risen and births have fallen, the number of births per midwife per year has dropped from 35 in 2007 to 26 in 2022.
The Darzi report acknowledged, however, that over that period, women’s medical needs during childbirth had become greater, due to factors such as rising maternal age and more women being obese or having diabetes.
An NHS spokesperson said: “The NHS has a duty to provide safe and personalised care to women and families according to best practice guidance and informed by evidence, and it is a fundamental requirement of maternity teams to inform and listen to every woman, respect their views, and help them to achieve the type of birth they would like.”
A Department of Health and Social Care spokesperson said: “Women need to know their wishes are being respected and listened to when giving birth and it is unacceptable that too many women are not receiving the maternity care they deserve.”