Justice begins before birth: a Christian response to the Amos Report

These opening words in Baroness Amos’ final report on maternity and neonatal services across England pack quite the punch. For nearly a year, she and her team investigated the state of this sector, following numerous scandals and failures over decades. Tragically, just like too many previous reports, she draws inescapably familiar conclusions. Women, babies and their partners are being routinely let down time after time by a system that is just not working.

As a relatively new Dad, some of the report resonated with me. When my wife was pregnant with our first child, we, like so many couples, experienced both the very best and the very worst of the NHS. We met midwives who went above and beyond. And we met some who treated with near contempt and rudness.

On the day of our daughter’s birth, our experience was generally very good. We had two midwives during the labour. The final one was superb. The first one was okay, if a bit distant and uncommunicative. She left the room a lot and I could never tell if it was because she had other patients, or some urgent admin to attend to.

It was the next morning that things became weird. One the one hand, we had the strange experience of multiple midwives trying to advise my wife on feeding, but offering completely contradictory advice. We also had a brusque doctor who came to check on our daughter, but spoke to us, sleep-deprived as we were, with the manner of a 1980s headmistress. You felt as if simply by being on the ward, you were doing something wrong!

But then later that first day, it was an older midwife who knew to tell the doctor when I casually told her our child had been sick and the colour of the vomit had been green. This led to a stay in high dependency, then special care before we were finally allowed home.

One of the days in special care, where feeding was a struggle, I am convinced God sent an angel. She was called Theresa* and she stayed with us for hours, helping, encouraging, trying different techniques. She even checked in on us a few days later, despite being off shift. Another of the team, Barbara*, was phenomenal as well. She was a ray of sunshine as we both adjusted to our new life.

Before I read Baroness Amos' report, I would have given our experience a 6 out of 10. But reading her findings about the sort of care other families received and I now understand, that not withstanding the difficult people and parts of our experience, it was overall more like 8 out of 10.

(*Names changed to protect identity)

What the Amos Report shows however is that what was just occasional for us, was, for too many women, their whole experience of maternity and neonatal care in England. I cannot begin to imagine how traumatic this must have been and your heart goes out to countless women and babies who’ve been let down.

The report said that women were simply not listened to. Here is just one example of a quote from a woman that highlights how poorly she were treated.

If you have ever given birth, or been in the same room as someone giving birth, you will know how utterly unacceptable the comments and experiences described above are.

But it gets worse. The report also found that racism, discrimination and structural inequalities are embedded throughout the maternity and neonatal system, that services are not designed in a way that ensures safety and that the system is fragmented and care is inconsistent. In other words, your maternity experience is a bit of a postcode lottery. It all depends on your location and the hospital you use, plus the staff on duty on that particular day.

It is worth pointing out that the discrimination highlighted in the report was also experienced by NHS staff as well. It is not just women. More than one in five ethnic minority staff reported discrimination from patients or members of the public in the previous 12 months, compared to just 5% of white staff. Religious staff were more than twice as likely to report discrimination from patients and the public than those reporting no religion.

All in all, the report is a damning read. Small wonder the first recommendation of the report is a statutory, national Maternity and Neonatal Commissioner to drive forward ‘urgent, systemwide change’.

The purpose of these Friday long reads is to try and provide a Christian response to the biggest issues of the week. As followers of Jesus, we care deeply about justice (Micah 6:8). This means ensuring each person, made uniquely in God’s own image, receives what is due to them. We also know that God has a special heart for the most vulnerable in society. And who could be more so than an unborn baby, utterly dependent on his or her mother for life itself? As Christians, we recognise the equal dignity of both women and babies, which is why in every pregnancy, we always say both lives matter. This report shows that both lives, in too many pregnancies, did not seem to matter enough to the services that should have cared for them.

I think this is why a Christian response to the report must start with a genuine grief and righteous anger over such high levels of failure. It is just not acceptable that so many women, babies and partners experience a total postcode lottery in terms of the care they may or may not experience if pregnant.

In this, we have joint cause with those who do not share our faith. As Christians, we do not have a monopoly on compassion! It is a good thing that so many other groups and advocates are committed to improving everything across maternity and neo-natal care. The particular and distinctive contribution the Church can make is to use this report to remind society that human life is deeply, profoundly and mysteriously sacred. While society grapples with 'personhood theroy' and is left floundering trying to determine when a pre-born baby becomes a 'real person', we know that true, human life begins at conception.

The Bible’s emphasis on the personhood of the baby in the womb is seen most explicitly in Psalm 139:13-14:

“For you created my inmost being;
you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.

Do you see and hear David’s marvel and wonder? After these verses, he goes on to say that God even saw his ‘unformed body’. Life is deeply sacred, because the Creator God is so directly involved in its conception. If anything is sacred, then it is worthy of the utmost respect and care. Christians should grieve over the successive and systemic failures in maternity and neonatal care for this very reason. Every mistake undermines the sacredness of life.

I also think Christians must and should be at the forefront of advocacy for better maternity and neonatal care and it is a wonderful thing to know God has his people in this sector, pushing and working for justice.

One of the tragedies of Christian public engagement is we are so often known for what we are against. For example, we are against assisted suicide, against gambling related harms, against pornography, against free speech infringements, against human trafficking. Of course, iIt’s not wrong to be against any of these things! And we can add abortion to the list. Evangelical Christians are surely against abortion because it involves the taking of a life that God had made in his own image, directly, by his own hand, in the womb.

But faithful, compassionate Christian advocacy must involve being for things as well as being against things. At CARE, we have key guiding principles that shape our work. We say that we are for people, we are for hope-filled solutions, and we are for truth and grace. These are deliberately framed in this way as an internal challenge. Are we just fighting bad ideas? Or are we also involved in advocating for things in the public square?

Let me stress: I’m not for one minute suggesting our advocacy on abortion is misplaced. Absolutely not! God calls us to contend for the most vulnerable and in scripture, this includes the orphan. We must cry out against abortion and especially in a context where the latest Office of National Statistics figures show 1 in 3 pregnancies across England and Wales now end in a termination.

But what I am also arguing is that we should also be passionately for better maternity care and not just because it ‘balances out’ our advocacy against abortion, or because it will make abortion less likely. We should advocate for the best possible maternity and neonatal care because it is the right thing to do. God cares about all human life, from conception, right through to life’s natural end. Any beginning of life engagement that we do should reflect this.

Alongside declaring the sacredness of life and adopting a holistic approach to engagement on these issues, Christians must champion proper care for all midwives, NHS staff and community teams. I know this might seem like an obvious point. But again, it seems to me that this is part of our distinctive approach and response.

No-one should be in any doubt that across England (and indeed the other nations that make up the UK!) there are many, many brilliant and committed midwives and other teams who provide outstanding care. The whole sector must be feeling so incredibly bruised by the publication of this report. In our churches, we may sit alongside midwives and healthcare professionals who will be feeling a range of emotions, from frustration and anger to fear about what it all means for the future.

So, remembering the words of Jesus, that we should build each other up and be kind to everyone, we must pray for midwives and for all those responsible for making the required improvements. And we must pray for NHS staff who have experienced discrimination, racism and bullying. May we as followers of Jesus never, ever, be complicit in such behaviour.

I am so very conscious in writing all of this that for some reading it, who may even agree completely, there is an unspoken, deep and dark pain that you are feeling.

All too often in the church, we’ve perhaps forgotten to remember those struggling with infertility. Sometimes this is linked to a diagnosed medical condition. But there is also something called ‘unexplained infertility’ where no test reveals any reason. It just doesn’t happen.

For some couples, going through this agony puts stress on their marriage. And all the while, they have to watch as their friends get pregnant and, in their church, they might sing songs about ‘children’s children’ and hear passages commanding the barren women to sing with joy.

The Amos report highlighted the failures across maternity and neonatal care. But the Church should recognise our own failure to love and have compassion on families who can’t have children, or who have suffered miscarriage or loss of a baby.

Infertility, whether it is explained or not, is a unique pain. We must be sensitive to this pain and be aware that is far more common in churches than perhaps we realize and that this should give us pause for thought. Let’s be compassionate about how we speak about babies, pregnancy and this report. You never know if your words are unintentionally causing further pain and sadness.

One of the saddest and most troubling parts of the Amos report is the fact she recognises that her findings are not new. Previous reports have highlighted many of the same issues and problems. So why has action been so slow?

I honestly think we too easily forget how complex birth and pregnancy can be. Each one is different and a woman’s experience with her first child may not be the same as her second and so on.

Working in midwifery requires a combination of skills, from medical knowledge to honed instincts, to kindness, patience and compassion. I wonder if what will really help bring change is not more reports, but more Christians to work in this area? In doing so, they would be standing in a fine tradition that you can trace as far back as Exodus, when two brave Hebrew midwives refused to kill baby boys, despite Pharoah’s orders.

That’s my chief prayer in response to this report. That decision makers would have the courage to make the changes needed. And im praying too for Christian midwives that they would know God’s grace to shine like stars as they help bring justice for babies both inside the womb and outside as well.