The national Maternity crisis is coming into full public view. Women and babies have suffered grievously during these times. Staff have been under huge pressure and have endured burnout and bullying. The reality is bitter for many women, for many families, and the scale of the loss has been largely ignored by politicians and governments. The NHS’ top management has done little to help. There is sorrow and bitterness amongst many women and their families. There is distrust of the maternity service by many women, reflected in social media and in conversations campaigners have with women using or thinking of using the service.
Felicity Dowling Save Liverpool Women’s Hospital Campaign
Safe maternity care is vital for everyone
The damage comes from a background of long austerity, an underfunded understaffed and poorly managed maternity service, and disrespect for women and babies in government policies. This translates fatally into maternity care despite at times the endless efforts from the staff involved.
There is a role here for Campaign groups like KONP, SHA and others who specifically want to keep the maternity service public, not for profit, free at the point of need, and as a national universal public service. There is a potentially huge role too for the trade unions to take up this issue.
The coming of the NHS improved women’s lives fundamentally as can be seen in the drop in infant mortality and maternal deaths.
We cannot overestimate the importance of using this time of focus on Maternity care. For the damage to be laid bare and not to be addressed will cause still worse care and generational damage. Women and their families have fought and won profound change before. Time to do it again.
Each of many aspects of maternity care has seen problems and those problems have been widely reported.
Safe staffing levels at the heart of good maternity care
Staffing in midwifery has been a problem for some years. Funding is one problem but the workload and lack of safety for mothers and babies has also worn staff down such that they leave the profession. In 2023 the Royal College of Midwives (RCM) reported the results of their survey.
◼︎Midwives and MSWs are working 100,000 unpaid hours a week to support maternity services.
◼︎ 88% of respondents worked additional unpaid hours.
◼︎ 74% of respondents often or always faced unrealistic time pressures and workloads.
◼︎ 87% of respondents did not feel their workplace had safe staffing levels.
◼︎ 26% of respondents worked more than five additional unpaid hours.
Despite the RCM survey this situation was not addressed by government.
A similar survey from the Royal College of Obstetricians and Gynaecologists also saw huge disquiet from its members, 63% of whom are women.
‘The RCOG is calling for urgent investment in a well-resourced Obstetrics and Gynaecology (O&G) workforce that is supported at every stage of their career, with protected time for training and leadership, flexible options for those nearing retirement, and improved working conditions that prioritise wellbeing and ensure all doctors feel valued. This is essential, recognising that a well-resourced and well-supported O&G workforce is integral to ensuring that women and girls receive the timely, high-quality, safe, and compassionate care they deserve.’
Dangers from cuts and shortages
Antenatal parent support Educators believe current NHS antenatal education does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes.
Post-natal care is threadbare Short staffing is not occasional but systemic.Care after birth in the hospital is brief, understaffed, and often unpleasant, with even mothers who have had caesarean sections being expected to care for their baby single-handed in the first hours in hospital (unless their partner or mother is there,) simply because of short staffing.
Post-natal mental health There has been some improvement in post-natal mental health support, but the situation is still pathetic.
The Birth Trauma Association said ‘We’ve been pleased to see a growing awareness in the NHS of the profound psychological impact of traumatic birth. NHS England’s introduction of the MMHS [Maternal Mental Health Service] was a hugely positive and welcome move because it meant that, for the first time, targeted support was available for these women.’
See also this MMHS report on recent developments. Suicide remains the leading cause of death in new mothers. But the cover is still patchy.
How many more reports before action is taken
Save Liverpool Women’s Hospital has collated twenty-two reports maternity services, all from respected researchers. This normalisation of damage is dangerous for future users of the service. It must not happen this time.
New Ockenden report on maternity failings
Midwife Donna Ockendon will publish the long-running report into maternity failings in Nottingham this June. This process has taken two long years. This is her third such report. The first Ockendon report [2020] was from Shrewsbury. It made headlines and was discussed in mainstream media. Many of her recommendations have been quietly ignored by Conservative and Labour Governments. Other respected people, including Bill Kirkup, have also produced horrifying reports, and again, although long lists of instructions have come from NHSE, little effective action has been taken.
The Amos report
Political appointee Valerie Amos is due to publish her national report on the maternity crisis for the Government. It is now expected in June. Thousands of women have sent her their bitter experiences. The experiences of so many women and children will be in the public eye, at least for a while. Very many women have had a joyful experience of giving birth, but for some, it has been appalling, and it is getting worse.
The Interim Amos report said: “Time and time again, families who have engaged with the investigation say that they are doing so because they do not want the same to happen to any other family. And yet they are seeing the same failures repeated. It is also a source of continuing distress to families and great frustration to staff that the areas identified in previous reviews and investigations as requiring action do not seem to have been addressed or have only been partially addressed. This cycle must stop.”
Mother and infant deaths in the UK are a national disgrace.
“The UK ranks among the higher neonatal and infant mortality rates amongst advanced nations. In 2022-24, 252 women died from direct or indirect causes during or soon after pregnancy among 1,969,321 maternities, meaning that the rate of maternal death for this period was 12.80 per 100,000 maternities. In 2018, New Zealand had 1.7 maternal deaths for every 100,000 live births”.
In response to the interim report from Baroness Amos, the Save Liverpool Women’s Hospital campaign said: “At the heart of our campaign, and of other such campaigns around the country, is the wish to make Maternity a healthier and happier experience for mothers and babies. We mourn those whose lives have been lost, we send sympathy to those who have been injured, physically, mentally, or emotionally, to those caring for injured babies and children and those who have been bereaved. We also care for the staff who have been worn out trying to make an under-resourced service as safe as it can be. But the service must be improved.”
Commenting on a campaign to reduce midwives’ working hours, Gill Walton, Chief Executive of the RCM, said: “Midwives and maternity support workers are facing extreme pressures and as this campaign highlights, they are exhausted, overstretched and working in unsustainable conditions.
Maternity outcomes, poverty and inequality
Poverty makes us vulnerable to poor outcomes, but better care is important. There can be no casting off the responsibility on professionals to provide safe care because we are poor, black, gay, trans, traveller, or migrant.
Poverty features largely in the causes of such differences. Nevertheless, many of these deaths could have been avoided by better care.
‘MBRRACE-UK assessors [Reducing Risk through Audits and Confidential Enquiries across the UK]felt that improvements in care could have made a difference for 45% of the women who died between 2021 and 2023.’
Government cannot plead ignorance
The Government is well aware of the damage being done to mothers and babies not just through the reports but through the damages they are paying out through the courts.
The Government pays more in legal damages to mothers and babies than they pay to run the whole service.
The Birth Rights Charity said: “An analysis based on NHS figures shows that the potential cost of maternity negligence claims in England since 2019 has reached £27.4 billion, which significantly exceeds the estimated £18 billion budget allocated to maternity care over the same period”.
Additionally, in these legal damages, the children damaged at birth who have poorer parents get lower damages than those from richer families even though the richer families are better placed to provide such support
Life-changing experiences and lost lives
The experiences of women in this scandal are horrific but out of respect we will not detail individual cases here.
The Birth Trauma Parliamentary report (led by Theo Clarke) about experiences of mothers giving birth in the current under-staffed and under-resourced system said:
‘Research shows that about 4-5% of women develop post-traumatic stress disorder (PTSD) after giving birth in the UK. Studies have also found that a much larger number of women – as many as one in three – find some aspects of their birth experience traumatic. Birth Trauma affects 30,000 women across the country every year. 53% of women who experienced birth trauma are less likely to have children in the future and 84% of women who experienced tears during birth, did not receive enough information about birth injuries ahead of time.’
UK Maternity care lags behind
Across the globe, outcomes for maternity improved in the first two decades of the 21st century, except in the UK and the United States. Here in the UK, Maternal death rates have increased to levels not seen for almost 20 years.
“The latest set of data presented by the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) Collaboration investigation into maternal deaths in the UK shows that the mortality rate for women who died during or soon after pregnancy between 2022 and 2024 was 20% higher than the maternal death rate between 2009 and 2011, when the UK government set an ambition to halve the rate of maternal deaths in England by 2025.”
Closures, mergers, work stress and burnout
The Times published a report saying 31 maternity units have closed since 2014, “reducing the total number from about 190 to 130” The outcomes in some of these merged facilities have not been good.
The Royal College of Midwives said in January 2026
“Our members tell us they are exhausted, overstretched and working in unsustainable conditions. 45% of midwives report burnout often or always, and only 16% feel there are enough staff to do their job properly. Midwives work an estimated 100,000 unpaid hours every week just to keep services functioning, with 87% saying their units are not safely staffed.
RCM representatives are supporting our members in the workplace to raise these issues with their employers. These include breaches of the Working Time Directive and Agenda for Change contracts that try to protect both staff and patients from working conditions that put women and babies, as well as staff welfare, at risk. These include action on chronic understaffing, inadequate investment, and system-wide pressures that make current working patterns unsustainable.”
They also said, “When staffing isn’t safe, neither is care.”
New reports – old lessons repeated
These formal reports tell us what women have been telling us for some years. Word-of-mouth reports reflect a deteriorating service, and this unpleasant reality is now being reflected in major reports. The Save Liverpool Women’s Hospital campaign has collated many of the formal reports here.
These reports can still be important if we can use them to build massive public support for fundamental improvements in the staffing, funding, and policies in the maternity services. The voices of women must be heard, and the service must be provided with due respect to its foundational role in healthcare and in the lives of every mother, every baby. Without an action to drive through these changes, the current situation will fester and be normalised. We must seize the time, spread the word in the workplaces and communities that the Government must be forced to act by the sheer weight of public organisation on the issue.
There are already campaign groups amongst black mothers, amongst bereaved families, amongst grassroots midwives and student midwives, unable to find employment despite the huge need for more midwives.
Already, maternity is a huge issue on social media amongst women of childbearing age.
This is not news to the Government nor to politicians in general.
Austerity, gender inequality and consequences
Governments have long known of the damage being caused to mothers and babies by austerity and by the cuts in maternity care. This current situation cries out for action. The deliberate underfunding and neglect of maternity services sit squarely in the policies of austerity. Austerity has been described by the Women’s Budget Group as gender-based violence.
A major report from Oxfam said.
Austerity is not just a gendered policy; it is also a gendered process in its ‘everydayness’ – the way it permeates the daily lives of women specifically: in their incomes, their care responsibilities, their ability to access services as essential as health, water and transportation, and in their overall safety and freedom from physical violence in the home, at work and on the street.
Researchers Walsh, D. and McCartney, G from Scotland recently reported that:
“Death rates in 3 more deprived parts of the UK increased markedly (in some cases spectacularly), meaning that on average people were dying younger and in greater numbers than before. For example, female mortality rates among those living in the 20% poorest neighbourhoods of Leeds increased by almost 20% between 2010 and 2019; premature mortality rates increased by 12% and 15% in the equivalent parts of Liverpool and Glasgow respectively”.
The Royal College of Obstetrics and Gynaecology said: “Action to tackle inequalities in women’s health requires coordinated and collective efforts from all parts of government. All government initiatives to improve women’s health, including specific women’s health plans and strategies, must make visible and strong connections with all relevant departments to achieve sustainable and long-term improvements to the wider factors shaping women’s health.”
Migrant charges and maternity outcomes
Migrant and refugee women face particular problems. We know of many cases of such situations where women cannot afford to pay the NHS fees expected. This can lead to women not attending for care because of fears of such charges.
Pregnant Women in the asylum system can be moved at will by the Home Office or their accommodation provider, which disrupts maternity care. Losing a record can put babies at greater risk.
Migrant women will be charged 150% of NHS costs charged up to£14000 for a complex delivery. This has been shown to affect women’s mental health.
Maternity Action (unsuccessfully) took the Government to the high court trying to remove the maternity charges for migrant women after “The MBRRACE-UK review of maternal deaths found that three mothers who died may have avoided maternity care because of NHS charging, pointing to the significant risks to maternal health associated with the Government’s charging policies. These charges must be suspended before any more harm can be done.”
Fear about the state of the Maternity Service service A common danger amongst oppressed women is that they do not register for antenatal care. More recently the fear of the state of the service has led others to avoid hospital all together, yet home birth services are not well provided, and free birthing, though promoted by some influencers can be dangerous. Trans parents reported in a small survey that they were likely to avoid antenatal and, if possible, hospital care for fear of ignorance or discrimination.
Birth Rights did a recent report saying that migrant women with NRPF (No Recourse to Public Funds) had higher risks of adverse maternal outcomes (emergency caesarean, severe maternal morbidity), their infants were more likely to have low Apgar scores and were less likely to receive skin-to-skin contact. Although infants of women with NRPF did not show higher risk of neonatal death, infants of women with unknown visa status had the highest risks of preterm birth, low birthweight, and neonatal death.
Home births have been restricted
There are too few highly experienced midwives. The churn of midwives has seen more experienced staff leave, and those who remain often have little experience of home births. Where teams do develop, they are often called into the hospital because of staffing issues there.
Birth rightssay: ‘Home birth is and should be seen as a core part of maternity care. Yet the information we hear on the ground demonstrates that home birth services can still be seen as an “add on” which can be easily withheld at the first sign of challenge. This fails to recognise how important home birth is to many women and birthing people in ensuring physical and psychological safety, particularly for those who have experienced past trauma and those from communities less likely to be heard and more likely to come to harm.’
And
‘Two thirds (66%) of the 119 Trusts for which we have information (either through an FOI response or intelligence from elsewhere) have either had service suspensions, strict restrictions, or frequent interruptions in the 12 months between October 2023 and November 2024.’
Campaigns of mothers, families and midwives
There are also campaigns like Pregnant then Screwed that fight for women’s rights at work during pregnancy, maternity leave, and when they return to work. Maternity Action has conducted surveys showing the real poverty and financial pressure women face during maternity leave.
‘In reality, only 13% of women access any form of enhanced maternity pay from employers, down from 44% in 2008. Most employed women rely on statutory maternity pay. This is paid at 90% of earnings for the first six weeks of maternity leave but then drops to £184.03 weekly: less than half (46%) the £400.40 national minimum wage for a 35-hour week and less than a third of women’s average full-time earnings. Some may only be eligible for Maternity Allowance if self-employed or in insecure work or the pregnancy is unplanned – but may be no better off because of the way Universal Credit deducts Maternity Allowance pound for pound.
‘Most families suffer a huge drop in income when one parent goes on maternity leave, which is aggravated by high food, energy and housing costs. Some of the hardest hit are those where the new mother was previously the main breadwinner or self-employed.’
Midwives not to blame
Midwives are not to blame for this crisis. Midwives are a unique and ancient profession working in a difficult, very hierarchical, and patriarchal situation. They are invaluable. Midwives are human, experiencing the same pressures in life as women they help. Their salaries are roughly in the national average for graduates when they start but it does not keep up over a lifetime. Of course, poor care or poor behaviour from any individual midwife or member of staff is unacceptable.
Student midwives work long hours in the hospital during their course but do not always get the required support from very overworked staff in the labour wards. University staff on these courses have complained too, of lack of time and resources to get the best outcomes from the individual students and the profession.
‘The RCM has previously reported that over one in five educators wanted to leave their organisation as soon as possible. In 2022/23, there were fewer new recruits than previous years, and, if this trend continues, there won’t be enough experienced educators to adequately train student midwives.’
Women’s choices
There are many controversies, with some campaigners blaming what they call a policy of natural births for the situation. See this from the Tory ex-minister Jeremy Hunt who implemented Austerity and continuing privatisation policies in the NHS. However, as this crisis has grown, the proportion of caesarean deliveries and other medical interventions has grown, so that now spontaneous delivery is less common than assisted methods.
Women’s right to choose where and how their baby is born has been severely restricted, Homebirths are seen as of secondary importance. Some women feel pressured to have interventions they do not choose and sometimes those to which they do not consent. Birthrights and other organisations have a checklist on consent. It is a sad situation where this is a common topic amongst pregnant women.
In the majority of labours, spontaneous vaginal delivery is safe and good for the mother and baby. A healthy woman going into labour is statistically likely to have a good outcome, but there are risks that require resources and help. The World Health Organisation said ‘Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed,” said Dr Ian Askew, Director of WHO’s Department of Sexual and Reproductive Health and Research and the UN joint Human Reproduction Programme, HRP. “But not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby’.
This damage to women and babies has been done in plain sight of governments
The major report came from MBRRACE-UK stated:
‘In 2022-24 the overall rate of maternal death in the UK was 20% higher than it was in 2009-11 when the government set an ambition to halve the rate of maternal mortality in England. Exclusion of maternal deaths due to COVID-19 has a minimal impact on this figure, emphasising the importance of renewed efforts to tackle maternal mortality.’
And
‘Inequalities in maternal mortality persisted in 2022-24. Compared to women aged 25-29, women aged 35 or older were nearly two times more likely to die. There was a nearly three-fold difference in maternal mortality rates for Black women compared to White women. Asian women’s risk of maternal death was also slightly higher compared to White women. Women living in the most deprived areas continued to have a maternal mortality rate twice that of women living in the least deprived areas.’
Racism, poverty and health inequalities
The damage in the 21st Century maternity scandal has been across the whole birthing population but worst damage has been to working class women, to black women, brown women and to Gypsy, Roma and Traveller women: ‘[There were] high rates of miscarriage, pregnancy loss and/or child loss reported by Gypsy, Roma and Traveller research participants, with very few participants having received any professional support relating to these experiences.’
There is a North/South divide in the maternity crisis, with higher levels of infant deaths in the North than the South. This is widely known, with the Northeast suffering the worst. A recent report says:
‘The maternity services most consistently reporting lower-than-average deaths included Portsmouth Hospitals University NHS Trust, Royal Free London NHS Foundation Trust, and University College London Hospitals NHS Foundation. Those most consistently reporting higher-than-average deaths included Sandwell and West Birmingham Hospitals NHS Trust, Liverpool Women’s NHS Foundation Trust, and The Leeds Teaching Hospitals NHS Trust.
‘All ten organizations with the highest comparable 10-year mortality rates were in the Midlands and North of England, and all fifteen organizations with the lowest mortality rates were in the South of England. These findings suggest that babies in the Midlands and North of England are more likely to die before, during, or shortly after birth than those in the South. This adds to longstanding findings on mortality inequalities in England’s North and South regions, including recent reports from the UK government (2019) and The Northern Health Science Alliance and N8 Research Partnership (2021).’
Yet we in the Save Liverpool Women’s Hospital Campaign are struggling still to save our hospital – seriously underfunded and operating with far less staff than we want to see. Please sign our petition.
What the maternity service needs
Respect for women and babies. Respect for the choices women make about their care.
A growing public campaign for excellent maternity services
Maternity healthcare for all. Free at the point of need, in a national public service system.
Democratic local oversight of conditions in maternity services.
Significantly better funding.
Protection of and improvement of the midwifery service, with the midwives in a protected role.
Better staffing ratios. Midwives need time to think. They need improved workloads and time to reflect, discuss, and learn.
Limits on working hours for midwives (see this petition and Leah Hazard’s work on this issue).
Better staffing ratios for obstetricians.
Improvements in the buildings in which many babies are born (see this report).
Action to improve outcomes for the groups of women who currently have bad outcomes, including women from poorer areas and Black, Asian and Gypsy, Roma Traveller women, and women from the North. This action has to come as an addition to overall improvement, not putting a patch on a bad service.
The reinstatement of the NHS as a service that respects all its patients and staff. Make the NHS once again a great place to work.
The reinstatement of the NHS as a service that respects all its patients and staff. Make the NHS once again a great place to work.
Investment in gynaecology care. This is scandal in itself. Employ the staff, grow the service end the endless waits for care!
Action against poverty, including action to improve housing and maternity pay.
An ending of Austerity and all the damage it has done to women and their babies and children.
We should take the issue into the communities, into the workplaces, into the Trade Unions, into women’s spaces. Please make contact if you want to help.
Felicity Dowling
[ Contact on [email protected])
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