Hansard

The birth of a child is probably the most significant and special event for any mother, but in Scotland today, sadly, that is not always the case. Last week, the BBC’s “Disclosure” programme reported on the tragic case of Jacqui Hunter. Jacqui died in childbirth from an amniotic fluid embolism. She had been given eight times the recommended dose of the drug used to bring on labour. An NHS Tayside review found that higher doses of that drug increase the risk of an amniotic fluid embolism and that the incorrect dose

“must be considered as a major contributing factor to AFE and subsequent death”.

The panel also said that Jacqui should have been informed of the medication error. Her grieving husband, Lori, only found out after her death. Thankfully, deaths such as Jacqui’s are rare. However, for far too many women, childbirth can be a difficult experience. As Lynsey Hamilton, a maternity campaigner, said when talking about her experience of pre-eclampsia:

“You will see the headlines and hear the statistics. Behind them there are families, mothers and babies who are being let down throughout Scotland due to the lack of funding and investment in maternity services.”

Last month, I travelled to Wick in Caithness, where I heard stories of mothers being forced to travel more than 100 miles to give birth, despite Wick having an amazing midwife-led maternity unit. I heard from the Caithness Health Action Team about a mother expecting twins who gave birth to her first child in Golspie and then continued the journey in two separate ambulances for the second twin to be born in Inverness. Nine in 10 women in Caithness give birth in hospital in Inverness—many of them are induced—but, despite the efforts of midwives, that does not mean that they receive acceptable maternity care. That is because Raigmore hospital is bursting at the seams. Women at the start of labour are told to go home and wait, but as home is more than 100 miles away, they end up wandering the streets of Inverness, sometimes at night.

I heard from Ashlyn, who arrived at the hospital to be induced but was told that it was too busy and was asked if she could come back two hours later. That went on and on and, in the end, she waited more than 12 hours to be induced.

Raigmore hospital’s maternity unit was supposed to be upgraded, but the Scottish Government paused the funding days after the unit was approved for development.

Across Scotland, our rural and remote communities want young families to stay and thrive. Instead, mothers are being forced to choose between healthcare and the place that they call home. In Stranraer, the closure of local maternity services means that expectant mothers are forced to travel 140 miles on a round-trip to Dumfries for care.

Claire Fleming, who is based near Stranraer, had children in 2012, 2015, 2019 and 2021, so she has seen the decline in maternity services throughout her four pregnancies. Her first daughter was, unfortunately, stillborn, but Claire says that she received outstanding support. In 2015, when Claire had her second child, she had a named midwife, and she had to go to Dumfries for an appointment only once. By 2021, when she had her fourth child, and extreme morning sickness, she had to make the 140-mile return journey for every single appointment—even appointments that were just five minutes long. The treatment in that instance was a drip in her arm. As Claire has asked many times, why could that not have been done closer to home? Women in remote and rural areas are right to call that out.

We know that services can be better. Orkney, which I know is close to the cabinet secretary’s heart, may be one of the most remote parts of Scotland, but its maternity unit has met the UNICEF gold standard. The unit is run by midwives, who are supported by consultant obstetricians, but mums know that in an emergency they will be transported via helicopter to Aberdeen. There are around 180 births a year in Orkney but, unlike in Caithness, around 80 per cent of them happen at the local maternity unit.

There is more that we can and should do in rural and remote areas, but the centralisation of services for mothers and babies is a nationwide issue. Families from Dundee to Lanarkshire have raised concerns about their specialist neonatal units being downgraded. Of course everybody wants the sickest, most premature babies to receive the highest standard of care. “The Best Start: Five-Year Plan for Maternity and Neonatal Care 2017–2024 Report” outlined the new model in 2017, and it recommended up to five intensive neonatal units. However, the Scottish Government has decided to deliver the minimum of three, meaning that women could be separated from their babies or forced to travel hundreds of miles just to be with them. The Scottish Government must listen to local families and clinicians, working with them, not against them.

The failures in maternity care are not just about geography. Last week, an inspection report highlighted failures at the Royal infirmary of Edinburgh maternity unit, which is less than four miles down the road from where we are now. Expectant mums are waiting as long as 29 hours to be induced, and they have been sent to other hospitals because there simply was not enough room. Only 13 per cent of the charts for patients’ essential observations were fully completed. Women were left alone in pain, with no call system to ask for help. There were delays in the escalation of care, and midwives were in tears because of the pressure.

An unannounced inspection in Ninewells earlier this year painted a similarly damning picture. Across Scotland, women are being let down at one of the times in their lives when they are most vulnerable.

I heard from Julie Keegan, a national health service nurse in Glasgow who works in intensive care, who noticed that her newborn son Mason was hypothermic, listless and struggling to breathe. She rushed to the city’s Royal hospital for children, where Mason died six hours later. A significant adverse event review later found that his temperature had been recorded as 35 degrees, when it was in fact so low that it was unrecordable, while other records had not been completed, leading to a failure to recognise just how sick he was.

Julie believes that a toxic workplace culture played a part in Mason’s death, and she backs a national investigation into maternity and neonatal services. She said:

“It is a complete whitewash. They should be working with families, not fighting them, to ensure that this never happens again.”

Too often, the response to such tragedies is a veil of secrecy. What is more, Mason’s tragic death is not Julie’s only experience of poor neonatal or maternity services. Earlier this year, expecting another child, she was given an appointment to be induced on a Monday. She ended up waiting for four days, because the maternity unit was short staffed.

Experiences such as those are deeply distressing for the mothers and families involved. They are also distressing for staff. Across Scotland, front-line NHS staff are overworked, understaffed and burnt out. The Ninewells inspectors found a 33 per cent shortfall in the number of experienced midwives. The NHS Lothian report found that midwives at the RIE were “emotional and tearful” while they talked about the

“overwhelming feeling of helplessness, frustration and worry for not only patients, but staff safety.”