A birth doula recounted a consultant “barking” at a bereaved mother for not attending the ward sooner after her waters broke, as a damning investigation revealed widespread failings in maternity and neonatal care within the National Health Service (NHS).
The incident, detailed in a report examining systemic issues in English maternity services, is one of numerous examples of insensitive and, in some cases, racist treatment experienced by families during and after pregnancy loss and childbirth. The investigation uncovered a pattern of inadequate staffing, a lack of accountability, and deeply concerning instances of discrimination.
The doula, whose name was not released, described the consultant’s behaviour as deeply damaging. “They said, ‘Well, why didn’t you come sooner? Are you stupid?’”, she reported. “Now, how can you accept care from somebody who is so dismissive of you, and who talks down to you, and is so condescending?”
Another family member described feeling dismissed by staff following a baby loss, stating, “They just wanted to get rid of us and nobody really took that time to give us that care really.” The family were then told, as they were leaving, “Make sure you cover his face because you don’t want to upset anybody.”
The report also highlighted systemic racism directed at Black and Asian women. Asian women were, in some cases, stereotyped as “princesses,” implying they were overly demanding and unable to cope with pain. One community organisation reported hearing a staff member say, “The bloody Asian ones just go on and on and on.”
Black women, conversely, were described as having “tough skin” and being able to tolerate excessive pain, while also being stereotyped as angry or aggressive. One woman who participated in an evidence panel for the investigation stated, “I was begging for help… I was made to feel like I was that aggressive, angry black woman. But that isn’t me.” Another added, “I feel like, for us black ladies, they feel like we can handle the pain, even when we are complaining we are in pain.”
Families also reported a lack of transparency and alleged “cover-ups” by NHS trusts following traumatic births and baby loss. One family member said that requested medical notes in paper format differed from those sent electronically, revealing “amendments” and redactions. Another claimed a trust produced “magical notes” three years after the event, which they knew to be inaccurate.
Underlying these issues was a consistent theme of inadequate staffing and resources. Midwives reported being consistently overstretched, often juggling multiple tasks due to staff shortages. One midwife described being called to a busy delivery suite outside of her familiar area, stating, “So we are half the time having to inquire people what to do… We’re not providing the same service that the delivery suite midwives can do because they know it like the back of their hands.”
Midwives also expressed “embarrassment” at their profession due to public scrutiny and reported struggling with burnout. The investigation also found maternity rooms frequently out of service due to disrepair, including leaking roofs and fire hazards, forcing staff to undertake basic repairs that diverted time from patient care.
Baby Loss Family Advisors, a certification program for loss doulas, emphasizes the importance of continuity of care and wise advice throughout the loss experience, according to their website. The organization’s vision is to ensure every mother and her partner have access to a trained and nurturing advisor from the time of loss through the birth and afterwards.
