Midwives want to make childbirth miraculous – so what went so wrong in Nottingham? | Zoe Williams

The acronym ‘FOH’ for ‘Fuck off home’ was used beside the names of expectant mothers. Senior midwives advised others not to be ‘too kind’. But as this and other shocking evidence is brought to light, sexism is only one part of the story, writes Zoe Williams

It’s said to be mother nature’s stunning con trick, the single most helpful move in the propagation of the species – that childbirth might be the worst thing ever to happen to anyone, but once you are through it, you instantly forget how painful it was. And that is true, up to a point, although you can often remember enough of the surrounding detail – swearing at strangers, wishing you were dead – that you can infer the rest.

What you don’t forget, however, is what the midwives were like, and nor, even in moments of extremis, do you fail to notice if they’re treating you scornfully. Panorama tonight is about the maternity unit run by Nottingham university hospitals NHS trust, the subject of the largest maternity inquiry in NHS history, spanning 13 years from 2012, and covering 2,500 families. The details are hair-raising: “FOH” written next to women’s names on a whiteboard, which stood for “fuck off home”; accounts of senior midwives advising others not to be “too kind”; gut-wrenching individual cases of women being warned off coming in to hospital for so long that, when one finally arrived, her baby was dead and her perineum and vaginal wall had collapsed. And every one of those women will have known, on some level, even if she was in no state to ask for her notes or read them, that someone wanted her to “fuck off”. You get a superpower in a life-and-death situation, though it’s unclear how helpful it is: you can tell pretty fast who’s on your side and who isn’t.

This relationship, between a woman in labour and a childbirth professional, has a bit of adversarialism built in. There’s a lot of patriarchal baggage in medicine generally – women’s pain is routinely minimised and women of colour suffer most from this prejudice.

Donna Ockenden, the senior midwife writing the Nottinghamshire report, painted a picture of conscious and spoken bias at the maternity unit: “There was this ongoing thing that South Asian women would complain about pain more. But I don’t think it was cultural differences at all: I think it was just discrimination.”

The concept of “women-centred care”, coined in the 90s and taken as given by the 2000s (when I had my kids), never seemed to me to have at its kernel what I would think of as the first principle of caring – that you would actually listen to women and then do as they asked. You were encouraged to write a birth plan, while told throughout the pregnancy that upon first contact with reality it would most likely be torn up. You were invited to say what you wanted, unless what you wanted was pain relief or – heaven forfend – an elective caesarean, in which case you weren’t putting the baby first, and were no longer a fully fledged woman.

When you decided it was time for you to go to hospital, it could not have been impressed upon you more forcefully that you were likely making the wrong decision, and should take whatever pain you were in or urgency you were experiencing and wait for it to increase tenfold before bothering anyone with it. It was absolutely taken as given that people who managed the whole show on gas and air were somehow morally superior to everyone else, and the further away I get from that, the more flat-out bizarre I know it to be. Even leaving the patriarchy aside, there’s the unavoidable factor of clashing perspectives – it must be hard for a midwife who sees multiple births a week, some of which are epically long and dizzyingly high-risk, to take seriously the tribulations of someone who had a perfect ordinary water birth in less than 24 hours with a gorgeous baby at the end of it. Yet that still, from the birther’s perspective, was the worst 23 hours that have ever been lived.

But two things elevated this experience from horror show to bliss – three if you count the baby. First, even within a culture that treated you like a workshy drama queen, there was a huge amount of kindness and humour: there can’t be many people who go into midwifery wanting to make childbirth less miraculous. Second, there was a fundamental trust that, whatever your differences, you would all move heaven and earth for the same thing, for everyone to come out healthily the other side.

If that changed in Nottinghamshire, if parents didn’t feel that care, if the evidence didn’t support it, it’s not because human nature has changed. It’s not because the midwifery profession has been overrun by brutes. It’s because, in the words of one community midwife, the staffing levels weren’t safe, which meant disasters struck, which meant “you have to be resilient, and to be resilient you have to lower your compassion”. This looks like a story about women and children; it’s at least equally a story about austerity.

• Zoe Williams is a Guardian columnist

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