• Royal College of Obstetricians and Gynaecologists criticised for review into Walsall Healthcare Trust’s maternity services 
  • Trust was told to appoint a lead for its “normality agenda” and encourage staff to lead on “normalisation”
  • Charity warns that focus on normal births was “immensely dangerous” 
  • Recommendations were made despite normal births campaign being abandoned by the Royal College of Midwives last year 

A charity has criticised a royal college for what it said was “immensely dangerous” support of a trust’s “normal birth” campaign.

Bill Kirkup, the senior doctor who led the Morecambe Bay inquiry, also questioned recommendations made by the Royal College of Obstetricians and Gynaecologists to Walsall Healthcare Trust, which supported the pursuit of a normal birth agenda.

The recommendations were made in a recent review of the provider’s maternity services, and were also supported by a representative from the Royal College of Midwives.

The RCM was previously criticised for promoting normal births in the wake of the Morecambe Bay inquiry, which found midwives’ “overzealous” pursuit of natural child birth sometimes led to unsafe care. It dropped a national campaign around natural birth in August 2017.

Following the review in October 2017, RCOG advised the trust to “review intervention rates and suggest ways to reduce inappropriate interventions in line with the normality agenda”.

The report, obtained by HSJ via a freedom of information request, said the trust had not fully embedded its “normality agenda”, while recommending it appoint a midwifery lead for “normality” and encouraging staff to “take lead roles in various normalisation processes”.

Maureen Treadwell, cofounder of the Birth Trauma Association, a charity set up to support women suffering from birth trauma, said the “normality agenda” is not part of current national guidance and warned it was “immensely dangerous” for the report to focus on reducing interventions rather than reducing complications as this can “risk bad outcomes”.

She said: “I didn’t see the word consent in this document, it [the review] is so much about pursuing what is perceived to be the approved pathway. It has nothing to do with woman centre care.”

Dr Kirkup, who led the Morecambe Bay inquiry, told HSJ: “While I understand and support the desire to reduce inappropriate interventions, I’m not keen on expressing this as ‘the normality agenda’.

“Experience elsewhere suggests that if a new approach is introduced unselectively it can lead to problems, and we should recognise the need for caution when change is made.”

RCOG was commissioned to carry out the review after an inspection by Care Quality Commission in June 2017 found evidence of an “oppressive” and “bullying” culture within the trust’s maternity department.

According to the review, the trust began promoting “normalisation” following a CQC inspection in 2015, which found high rates of caesarean intervention.

In a statement, RCOG said the terms of reference for the review, that were agreed with the trust, included a request to assess intervention rates and suggest ways to reduce inappropriate interventions.

It also pointed to guidance from the National Institute of Health and Care Excellence which recommends that pregnant women at low risk of complications are suited to plan to give birth in a midwife led setting.

The college added that achieving a “sensible and safe balance” no model should be under or over medicalised.

The RCM said it had a joint approach to independent reviews with RCOG, but said it is not alerted when the reviews take place and does not see the reviewers work.