We are the parents, (whose daughters lost their lives avoidably due to catastrophic failings in care at the Shrewsbury and Telford Hospital Trust (SaTH)), who:

·       Lobbied former Secretary of State Jeremy Hunt, and the government for an investigation into SaTH's maternity services which resulted in the Ockenden Review, 

·       Lobbied the police for a criminal investigation into the same which resulted in the ongoing Operation Lincoln,

·       Lobbied the government for additional funding for maternity services in England and Wales

On the 25/9/23 we wrote to the incumbent Health Secretary, The Rt Hon Steven Barclay MP, to formalise a request we made on the 22/9/23 via X (formerly Twitter), for a public inquiry into maternity services.

He has yet to respond to our request, despite follow up communications and regional and national media coverage.  We are launching this petition to ask the Department of Health and the government to commit to a national public inquiry into maternity services, because without a top down review that leaves no stone unturned, the oft repeated national failings will continue to cause avoidable harm and death and devastate families.

We know that you probably won't care until you do care - by that we mean, the concept of a 'dead baby' is not one you will ever consider, until you hold your own newborn in your arms, dead after catastrophic and avoidable failings in their care...

But instead of hoping for the best and believing it won't happen to you, listen to those of us who have experienced this life shattering reality as we push for the deepest, most meaningful change possible.  This can only be uncovered and delivered with a national public inquiry.

Shockingly, despite intense scrutiny from the regulators, independent investigators, the police, and national media, as well as increased funding and overarching recommendations for change, maternity services in England and Wales have not improved, and are deteriorating.  

The latest figures, (from 2021) show a sharp increase in maternity death rates: for example, there were 2,473 stillbirths compared to 2,292 the previous year, and 1,151 neonatal deaths compared to the previous 1,051.

Not only are death rates increasing, but the raft of recommendations and the additional funding are not getting to the heart of issues.

The Care Quality Commission (CQC) has been assessing over 130 hospital maternity services that haven't been inspected since April 2021.  56 services have so far been rated with 18 requiring improvement and 7 entirely inadequate.  This includes Leicester Royal Infirmary and Leicester General Hospital whose ratings for maternity care were downgraded just last week.  

The CQC report into these units included details of dangerously low staffing levels putting the safety of mothers and babies at risk.  This is deeply concerning, but what shocked us more was the fact they had a staggeringly high number of perinatal deaths in just six months.  It is stated 51 of these were reviewed but only 22 cases resulted in learning or actions.  Perinatal deaths are not common.  Every single one must be investigated, and action taken to prevent failings being repeated.  The fact that so few resulted in learning is suggestive that the causes of deaths in most cases were already known about.  I.e., they were avoidable and followed similar mistakes made in the past.

Required actions are not being taken to protect women and babies.  This is appalling, but sadly not uncommon – which is why we need to draw a line in the sand and force the government's hand and ensure there is a public inquiry into maternity services.

Underpinning the maternity catastrophes that have been well publicised such as Morecambe Bay, East Kent and the Shrewsbury and Telford Hospital Trust was the fact the midwifery and obstetric staff worked independently of each other, and midwives proactively worked to avoid escalations in care even when they were clearly needed.  

A normal birth agenda is cited in so many of the cases of avoidable harm and death that the authors of the reports into the aforementioned hospitals, Dr. Bill Kirkup and Donna Ockenden wrote.  It was so clearly an issue that the NHS and the Royal College of Midwives (RCM) listened for once.  The latter abandoned its normal birth campaign in 2014, and in February last year, NHS England instructed hospitals to stop attempting to hit low total caesarean-section targets.

If you follow, as we do, many spokespeople for the midwifery profession you will read how they continue to promote the natural birth agenda however, as well as alternative therapies to support birth or to alleviate trauma following loss.  They are continuing entirely unchallenged.  It is as if they are untouchable.  In the last week a mother-to-be who was refused a caesarean section at SaTH has had the findings of the inquest into her daughter's death in 2021...her death was preventable and caused by neglect.

How many more perfectly healthy babies have to die.  How many more families have to be destroyed.  Because you never get over the death of a child.

The ideology of a normal birth at any cost continues as identified in this recent Telegraph Article: https://www.telegraph.co.uk/news/2023/09/23/nhs-trusts-women-natural-birth-caesarean-section/

Where it is written:

East and North Hertfordshire NHS Trust's internal policy document issued in September 2022 states: "East and North Hertfordshire Maternity Service promotes a culture of normality and focuses on keeping pregnancy and birth normal for all low-risk women."

Bolton NHS Foundation Trust's website says it offers "great facilities, pride ourselves on the individual care and attention each woman and family receives and we promote a philosophy of normal and natural labour and childbirth and midwives support women to achieve this".

County Durham and Darlington NHS Foundation Trust's website states: "Our vision is to provide care that is centred on your individual needs, and to support you to achieve as normal a pregnancy and childbirth experience as possible."

Macclesfield Hospital (East Cheshire NHS
Trust) states on its website: "Our team believes in the importance of promoting normality in pregnancy, labour, and the postnatal period, the service will strive to maximise continuity of carer and one-to-one midwifery care throughout labour"

Surrey and Sussex Healthcare NHS Trust's website states: "We would only advise that you choose to give birth by planned caesarean if we have identified a risk for you or your baby in awaiting spontaneous vaginal birth... for the majority of women they are not the safest mode of birth due to increased risk of heavy bleeding at birth and common complications of post-operative recovery."

Luton and Dunstable University Hospital actively encourages "women who have a straightforward pregnancy... to have their baby at home in familiar surroundings or in the Midwife Led Birth Unit" only recommending a hospital delivery suite "for women who have a medical problem, complication of pregnancy or have experienced a complication in a previous pregnancy".

An internal document from Mid and South Essex NHS Foundation Trust states: "The Trust does not support caesarean section on maternal request", while another claims: "Maternity services throughout the UK are aiming to increase the normal birth rate towards a realistic objective of 60 per cent".

Barnsley Hospital NHS Foundation Trust's public board papers from August 2023 show it still operates a target "normal birth" rate of at least 58 per cent.

Safe maternity provision in the UK is not the norm.  As Donna Ockenden said in her report into the Trust where our daughters died: “childbirth is not safe for women in England.”  

Robust action is required of immediately.  Rather than disconnected and disjointed clinical and criminal investigations into hospital trusts across the country, a public inquiry into maternity services is the only way we can get to the root of the issues and create required change.  We recommend Donna Ockenden leads this.

If you agree, please add your voice to ours as we call on the government to launch a national public inquiry into maternity services so that we can ensure absolute fundamental change for this generation and the next.

Thank you.

Rhiannon Davies MBE and Richard Stanton MBE, parents of Kate who lost her life avoidably in 2009. Kayleigh Griffiths MBE and Colin Griffiths MBE, parents of Pippa who lost her life avoidably in 2016.