How Many More Reports?
I have lost count of the number of maternity reports I have read over the years. Every few years another inquiry lands. Another heartbreaking story reaches the headlines. Another family speaks out. Another set of recommendations is published with the promise that lessons will be learned and that things will change. Every time, I find myself asking the same question.
How many more reports do we need before we stop writing about the problems and start truly changing them?
Today has been no different. As the latest maternity investigation of Nottingham University Hospital Trust dominates the news, ahead of next weeks Amos National Maternity investigation findings. I follow with a heavy heart. Not because I am shocked by what has been uncovered, but because so much of it feels painfully familiar.
As a midwife, that was trying to improve care from within the system. I have sat in governance meetings, reviewed incidents, completed audits, contributed to action plans and implemented recommendations. I know the effort that goes into trying to make maternity care safer. I also know that despite everyone’s hard work, the same themes continue to emerge.
Women not being listened to.
Families feeling dismissed.
Poor communication.
A lack of informed consent.
Unsafe cultures where people are frightened to speak up.
Burnt-out staff trying to provide compassionate care in systems that no longer give them the time to do so.
The more reports I read, the more I wonder whether we have become experts at investigating harm but far less successful at preventing it. The names of the reports change, but their messages rarely do. Changing Childbirth, calling for woman-centred care and genuine choice. Better Births, placing continuity of carer and personalised care at the heart of its vision. The annual MBRRACE reports continue to highlight inequalities, delays in recognising deterioration and failures in communication. The Morecambe Bay investigation exposed deep cultural failings and the consequences of poor teamwork. Donna Ockenden’s previous review of Shrewsbury and Telford described repeated failures to listen to women and families (and now she is producing more reports for more trusts with surely the same themes!), Dr Bill Kirkup’s investigations identified toxic organisational cultures where learning was replaced by defensiveness. The Birth Trauma Inquiry gave voice to hundreds of women who described coercion, poor consent and experiences that have stayed with them for years. Now, once again, we are told that lessons must be learned. The uncomfortable truth is that we already know many of those lessons. We have known them for decades.
Listen to women.
Support staff.
Improve continuity of care.
Encourage multidisciplinary working.
Strengthen leadership.
Create psychological safety.
Prioritise informed decision-making.
Build cultures that learn instead of blame.
None of these ideas are new. So perhaps the question is no longer what needs to happen but why it keeps failing to happen. I do not believe the problem lies with individual midwives or obstetricians. Some of the most extraordinary people I have ever met work in maternity services. I have watched colleagues stay hours beyond the end of their shifts, miss breaks, skip meals and carry enormous emotional burdens because they desperately want to provide good care. They are not the problem. The system they are working within is.
When staffing is unsafe, relationships become impossible to build.
When continuity of care disappears, trust disappears with it.
When appointments become shorter and documentation becomes longer, meaningful conversations are squeezed into impossible spaces.
When fear of litigation and scrutiny dominates decision-making, defensive practice inevitably follows.
When exhausted professionals are expected to keep giving more and more of themselves, eventually something gives way.
I also believe there is a deeper conversation we rarely have. Birth sits within a healthcare system that has historically been shaped by patriarchal structures, where women’s pain has often been minimised, women’s instincts questioned and women’s experiences undervalued. Even now, despite childbirth being one of the most fundamental human experiences, there are times when it feels as though the woman herself becomes secondary to the process around her. Policies, guidelines and risk assessments matter but women matter too.
The irony is that at the same time intervention rates continue to rise, many women still leave maternity care feeling frightened, traumatised or unheard. It makes me wonder whether we have become so focused on managing risk that we have forgotten how to nurture safety. True safety is not created by paperwork alone. It is created through relationships which build continuity, trust, time, listening and kindness. These things cannot be measured as easily as performance indicators, but they shape birth in profound ways.
As I step away from my career in the NHS and into this new chapter with The Alternative Midwife, I carry a complicated mix of emotions. I feel sadness for a profession I love that is struggling under relentless pressure. I feel grief for colleagues who entered midwifery to walk alongside women but now spend much of their day chasing documentation, managing risk and firefighting impossible workloads and I feel frustration that the same recommendations appear year after year while the cultural transformation required to deliver them remains painfully slow.
I hope that by creating spaces for honest conversations, by helping women understand their rights and their choices, and by sharing the stories that too often stay hidden, I might contribute to change from a different direction. Safer maternity care will not come from another report alone, it will come when we understand that birth is not merely a medical event but a profound physiological, psychological and social experience. The only lesson I see we can take from these new reports is actually we do not need another list of recommendations, what we need is the courage to act on the ones we already have.
