Two days after giving birth, Juliana Nascimento Barbosa is still ecstatic about becoming a mother. “I’m so happy to have my baby,” she says from her bed in Queen’s hospital in Romford, Essex, smiling broadly.
To her left, her husband, Emerson, sits on a chair. To her right, their newborn son Dominic lies on a neonatal resuscitaire receiving phototherapy, a light treatment to help relieve his jaundice.
He is wearing a tiny nappy and his eyes are covered by a mask to shield them from the machine’s four bars of bright light.
It is helping to purge his tiny body of bilirubin, the pigment in bile that turns skin yellow in people with jaundice, because his liver is not yet strong enough to do that. He cries softly when a nurse takes a few spots of blood in a heel prick test to help staff monitor his condition.
Juliana is still in hospital – not just to look after Dominic but because, like so many women, the birth proved complicated.
Her labour was progressing, albeit slowly. But then a CTG (cardiotocograph) trace, to monitor her baby’s heartbeat, showed he had passed meconium – his first stool – while still in utero.
That can be a sign of a baby’s distress, perhaps because they have an infection or are not getting enough oxygen, explains Dr Kathryn Tompsett, the head of maternity and children’s care at Queen’s. “When that happens the priority is to get the baby born ASAP, usually within 30 minutes,” says Tompsett.
Such safety-first medicine is common in childbirth, where two lives could be at risk. A wrong decision can lead to a baby suffering brain damage and cost the NHS £20m in damages.
Things moved fast. By then Juliana had become fully dilated, which helped. Fifteen hours after her labour began, and six after staff ruptured her membranes to speed things up, Dominic was born.
He was delivered vaginally but only after Dr Georgina Lennon-Butler, a resident obstetrician, had used a ventouse suction cap to help get him out and made a cut – called an episiotomy – to create more space for that to happen.
That meant Dominic was classed as an assisted vaginal birth. His care illustrates the medical intervention that maternity teams increasingly use because childbirth has become more complex and more perilous.
Juliana is thankful for her son’s safe arrival and the care she received. Using Emerson to translate her native Portuguese, she explains that “I had one problem – I have depression.”
She namechecks two staff in particular who provided vital support during her daunting recent days and months: Mariane, a psychotherapist who is part of the hospital’s maternal mental health team, and Yassi, a midwife who helped deliver Dominic.
Both speak Portuguese. Their clinical and linguistic skills helped Juliana negotiate her labour and birth. Both proved reassuring presences while she delivered Dominic.
“Mariane’s my doctor for my head. I’ve seen her throughout my pregnancy. She’s been caring for my mental health. It was comforting to have her around at the birth. It made me feel safe,” says Juliana.
“Having Yassi there too made me feel more comfortable. She was my translator. She took care of me. It was very important for me to have her there.”
How was her birth experience overall? She selects Google Translate on her phone and taps. Her message reads: “Everyone played a very important role in our baby’s life. They were wonderful, very caring, and they made me feel safe, very safe. Labour is difficult for a woman and having such wonderful professionals as the team at Queen’s made us very happy.”
Juliana and Dominic received great care at Queen’s, where 7,000 babies a year are born. But many women who gave birth there in previous years did not. For years its maternity service too often provided substandard – and sometimes dangerously bad – care, the results of which included some babies dying.
In 2021, the Care Quality Commission (CQC), the NHS watchdog, rated it “requires improvement” and issued the same assessment after a further inspection in 2024. Queen’s was by no means alone in that low rating. The year before, the CQC said almost two-thirds of England’s maternity units were unsafe.
Queen’s, the third largest single site maternity unit in England, is run by Barking, Havering and Redbridge NHS trust (BHR). It is one of 12 trusts where Lady Amos has been investigating care standards as part of her England-wide review of maternity and neonatal services, which the government commissioned last year.
They were chosen because reviews of “multiple” trusts had found that they displayed “a pattern of similar failings: women’s voices ignored, safety concerns overlooked and poor leadership creating toxic cultures”.
Amos’s report is being published on Tuesday 30 June. It will become the latest in a long line of official inquiries to diagnose the widespread problems in NHS maternity care in England, which Donna Ockenden underlined in her review last week of the scandal in Nottingham in 2012-25.
She will also make a series of recommendations intended to make childbirth safer and better. The government will publish a maternity action plan before the end of the year.
However, since being rated “requires improvement”, Queen’s has made a series of improvements to its maternity service that led the CQC to declare the unit “good” after it inspected it again last August.
Matthew Trainer, BHR’s former chief executive who recently departed the trust, believes the trust has “turned the corner on a once troubled past in our maternity service”.
Wes Streeting, the former health secretary and a local MP, says the service has improved “in leaps and bounds” and its progress is “a huge achievement”.
How has it done it? It has involved hiring many more staff, putting in extra money, and paying more attention to the particular needs of women from the multi-ethnic, often poor communities in BHR’s catchment area. Half of the 7,000 women a year who give birth there do not speak English as a first language and 61% are from the top 20% most deprived neighbourhoods in England.
Changes began after the “requires improvement” rating in 2021, says Tompsett. Since then the maternity department’s staff headcount has risen by 147, from 552 to 699. That includes 22 more doctors, including 14 consultants, and 65 midwives. It has more midwives than ever before and reduced its vacancy rate from 16% to 4%.
“I’ve seen huge improvement”, says Tompsett, an obstetrician for 18 years. The extra staff have helped the service tackle what the CQC identified as a core problem: the delays expectant mothers were facing in the triage area – the maternity equivalent of A&E. The unit is now “more consistently” triaging women within the expected 15 minutes for all arrivals.
Since 2024 “flow coordinators” have been on duty around the clock across the maternity service to reduce the hold-ups mothers-to-be can face going from one part of it to the next.
Extra personnel are on hand to help out in the obstetric operating theatres, which are busier than ever because the proportion of babies arriving by caesarean section has hit 45%, both nationally and at Queen’s.
BHR has made determined efforts to help ensure women without English as a first language have a good birth experience. Volunteers such as Saba Asif and Jobaida Alam, who were born in India and Bangladesh respectively, work for the bilingual maternity support service.
They and their colleagues – mostly women who have given birth at Queen’s – work for free for several hours a week. “I tell them to relax and that even if they don’t understand the language that it will be fine, because we have interpreters – that they will be in good hands, in safe hands,” says Asif.
Queen’s has also managed to reduce the number of pregnancies ending in stillbirth. They fell by 31% over the past year, Tompsett says. Analysing data to produce a “heatmap” of the local postcodes where an unusually high number were occurring – they turned out to be areas of high deprivation – and then ensuring that midwives gave mothers-to-be there “dedicated one on one enhanced continuity of care” during their pregnancy has helped achieve that, she explains.
Trainer is realistic about the progress at Queen’s and the fact that it must keep improving. “These changes have led to more people saying they’ve had a good experience at Queen’s and to a fall in complaints,” he told the trust’s website when the CQC issued its positive rating last year.
“We have more to do and I know these improvements have come too late for those who have lost a child and those who experienced poor care. We still have more to do to ensure every mother and baby get the care they deserve.”
With maternity now arguably the NHS’s biggest area of failure, and headlines about poor care making mothers-to-be apprehensive about how they will be looked after when they give birth, the continuing overhaul at Queen’s offers optimism that improvement is not just needed but possible.
