By Jo Gould, Rathi Guhadasan and Pat Schan, SHA Maternal and Newborn Health Working Group
We note the recent confirmation of a rapid national maternity care investigation by the Health Secretary Wes Streeting, with cautious optimism. Whilst it places a much-needed spotlight on maternal and newborn health in this country, there is already clear evidence from previous maternity investigations and regulatory reviews that our maternity services are failing women, babies and families. Whatever the findings of this investigation are, those previous findings must be acted upon without delay to prevent continued avoidable harm.
The plan to look at the whole system of maternity and neonatal care is a critical move if vital improvements to the safety and quality of maternity care in the United Kingdom are to be made. The appointment of an appropriate taskforce panel, led by a suitably qualified and experienced Chair is central to the success of the review. Any recommendations from the investigation must be grounded in evidence if progress is to be made. Previous maternity enquiry recommendations have not been fully implemented or have been implemented without strong supporting evidence, resulting in the continued deterioration in the safety and quality of care received by women, babies and families.
The recent review into maternity services in Northern Ireland, led by Professor Mary Renfrew, exemplifies an expert-led, evidence-based approach to healthcare system review and reform. This should be the approach of the taskforce appointed by the Health Secretary to undertake the review of services. Otherwise, the risk is continued stagnation and deterioration in maternal and neonatal health outcomes in the UK.
The following areas should be considered urgently:
- Give voice AND authority to maternity service users. Their diverse voices should be at the heart of strategies to improve care. If we listen to women, we are much more likely to deliver services that meet their needs.
- Deliver local ‘Neighbourhood Health’ maternity services via integrated community-based, women’s health hubs. In line with the Women’s Health Strategy (Department of Health and Social Care, 2022), the focus should be on women’s health and care needs across the life course (including maternity) and should move away from a disease-orientated approach.
- Provide local maternity services as part of essential secondary care. As part of the move to services embedded in local communities, halt the widespread unit closures and centralisation of maternity services which impact equitable care and women’s choices. This includes avoiding the closure of local hospital maternity units, freestanding midwifery-led units and homebirth services. In line with the national ‘Birthplace’ study data from the National Perinatal Epidemiology Unit, labour and birth outcomes for healthy, low risk women and babies are better in midwifery-led units, compared to obstetric units.
- Focus on preventative health. ‘Sure Start’ type programmes to target inequalities, help eradicate the black and Asian maternal health gap and to address the specific issues faced by “exceptionally vulnerable women” (as defined in the May 2024 APPG Birth Trauma Report). Undergraduate and postgraduate training curriculums to be designed to meet the needs of all marginalised and vulnerable women and ensure that they receive timely, respectful and appropriate care
- Prioritise maternal mental health in line with physical health. Improve recruitment and retention of specialist perinatal mental health professionals. Maternal suicide is one of the leading direct causes of maternal death. This is shocking and preventable and must be addressed urgently.
- Urgently reinstate the national strategy to implement midwifery continuity of care for all women in the United Kingdom with resources targeted to provide all women with this model of care without further delay. The rollout of this model, led by NHS England and supported by the Royal College of Midwives was paused in September 2022 due to the shortage of midwives. Continuity of midwifery care is supported by high-quality evidence as the model to deliver safe and personalised care for women and babies. Women of Black and Asian ethnicity, women with mental health issues and women from socioeconomically deprived areas should be the first populations to benefit from this model to improve their poorer maternal health outcomes. Improve recruitment and retention to deliver this model sustainably and expand the midwifery workforce. Begin by addressing the current staffing and skills crisis (The UK is currently 2500 midwives short).
- Fix the workforce crisis facing maternity services – starting with midwives. The government must workwith all relevant Royal Colleges and healthcare unions to target pay and working conditions to improve recruitment and retention of staff and expand workforce capacity.
The exodus of midwives from maternity services, must be reversed. The number of new midwives joining the professional register fell by 12.5% last year and the removal of the student bursary means they face paying debts of £40,000 or more. The midwifery workforce, working in partnership with the wider maternity team, is critical to safe, high-quality and personalised care and losing experienced midwives as they burn out and leave threatens service quality and safety. The Lancet Midwifery Series and the newly launched World Health Organisation global strategy on implementing midwifery models across global health systems both recognise the critical role that skilled midwifery care has in optimising maternal and neonatal health outcomes, reducing health inequalities and improving women’s experiences of care. This evidence, together with the evidence regarding continuity of care models should be reviewed as part of the maternity investigation process.
We are facing a national emergency in maternity care, with maternal mortality rates at their highest for two decades. While we welcome the announcement of the review, this should not be used to delay urgent measures, such as improvements to staff recruitment and retention. The review itself should be rapid and phased, with early focus on those groups suffering the highest maternal mortality risk.
References
All-Party Parliamentary Group on Birth Trauma (2024). Listen to Mums: Ending the Postcode Lottery on Perinatal Care. Available at: https://www.theo-clarke.org.uk/sites/www.theo-clarke.org.uk/files/2024-05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf
(Accessed 23rd June 2025).
Birthplace in England Collaborative Group (2011). Perinatal and maternal outcomes by planned place of birth for healthy women with low-risk pregnancies: the Birthplace in England national prospective cohort study. British Medical Journal, 2011(343). Available at: https://doi.org/10.1136/bmj.d7400
Department of Health and Social Care (2022). Women’s Health Strategy for England. Available at: https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england#access-to-services (Accessed 23rd June 2025).
Renfrew, M. et al (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), pp. 1129-1145. Available at: doi:10.1016/S0140-6736(14)60789-3
Renfrew, M. (2024). Enabling Safe Quality Midwifery Services and Care in Northern Ireland. Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-midwifery-renfrew-report-oct-2024_0.pdf (Accessed 23rd June 2015).
World Health Organisation (2025). Transitioning to midwifery models of care: global position paper. Available at: https://iris.who.int/bitstream/handle/10665/379236/9789240098268-eng.pdf?sequence=1 (accessed 23rd June 2025).