Radical Systemic Reform Needed to Secure Safe Maternity Care in the NHS

It is difficult to articulate the profound suffering endured by those who have experienced preventable baby loss, injury, or maternal death. Understandably, families affected by such tragedies have campaigned tirelessly for thorough local and national investigations. Each family deserves to understand the cause of their loss or trauma, yet existing and previous reviews have fallen short of delivering resolution and accountability.

The crucial discussion surrounding the assurance of safe maternity care has intensified following the release of two major reports, authored by Valerie Amos and Donna Ockenden, and the appointment of Yvette Cooper as Secretary of State for Health and Social Care, presenting a pivotal opportunity for comprehensive system‑wide reform. “I intend to make this a personal crusade to restore the cradle at the heart of the NHS,” Cooper told The Guardian last week, emphasizing her commitment to establishing a new national maternity commissioner.

For women and families, entrenched systemic shortcomings have led to failures of compassionate care, as disturbing examples outlined in both reports illustrate. Unkind or unprofessional conduct is utterly inexcusable, and the life‑altering physical and psychological trauma resulting from inadequate care must remain recognized.

We also owe it to all staff groups, especially midwives, who are frequently blamed in the media, to acknowledge that they deliver high‑quality care to countless women daily, despite intense workplace pressures. The Amos inquiry revealed that only 22% of midwives felt they had adequate time to perform their duties effectively, and a recent Guardian report highlighted a growing number exiting the profession due to burnout.

Undermining and vilifying midwives serves no purpose. They constitute the sole professional group that accompanies women, babies, and families throughout every stage of the maternity journey across both hospital and community settings, forming the foundation upon which other services rely. To ensure the safety of women and babies, all staff must operate within supportive, well‑managed, and adequately resourced environments.

Public criticism of maternity services over the past decade may give the impression that poor care is widespread; however, regular national surveys conducted by Oxford University indicate that overall satisfaction with care has remained high and relatively stable from 2006 through 2024. Poor outcomes do not necessarily reflect poor care. The Ockenden review examined more than 700 maternity cases with adverse outcomes — including stillbirth, severe perineal trauma, and major haemorrhage — among over 41,000 births between 2020 and May 2025. In more than 80% of these cases, care was judged to align with best practice, or alternative management would not have changed the outcome.

Research from the Neonatal Data Analysis Unit at Imperial College London demonstrates that the number of term infants suffering brain injury from oxygen deprivation has declined between 2015 and 2021, and stillbirth rates have fallen — significant improvements. Nonetheless, data from the National Perinatal Epidemiology Unit at Oxford University reveal that the maternal mortality rate in the UK during 2022‑2024 was 20% higher than in 2009‑2011, and the Amos inquiry identified persistent inequalities, overt racism, and ongoing reports of physical and psychological trauma.

Incremental initiatives have produced unintended side effects. Efforts to enhance safety and expand maternal choice have coincided with a sharp rise in obstetric interventions. NHS data indicates that labour induction increased from approximately 20% before 2010 to over 34% by 2020, before modestly declining; caesarean section rates rose from 27% of births in 2016 to 45% in 2025, representing roughly 100,000 additional caesarean deliveries annually compared with a decade earlier.

A focus on interventions as the primary solution to maternity safety risks displaces resources and overlooks a fundamental aspect of maternity care: women require more than technical procedures. Some need compassionate support during loss, and all deserve skilled care, information, and trusting relationships with their maternity team. Continuity‑based midwifery — where women receive consistent care from the same midwife — has been shown to improve outcomes, yet few women currently benefit from this model.

There is a risk that political, professional, and media discourse may divert attention from the central priority: delivering safe, equitable care grounded in robust evidence and genuine partnership with women and families. The Amos inquiry concluded that nothing less than radical whole‑system transformation is required.

The future health and wellbeing of our population requires nothing less.

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