Maternity care in the United Kingdom is in crisis. Despite years of reviews, inquiries, and reforms, avoidable harm continues to occur every day in maternity units across the country. While politicians and administrators debate policy, funding, and systems, the heart of the issue lies elsewhere: it is not political-it is medical and midwifery.
As a Consultant Obstetrician and Gynaecologist as well as a medico-legal expert, I read about the same tragedies repeated time after time. The same errors, the same missed signs, and the same preventable outcomes appear with alarming regularity in the clinical records and in legal cases.
This is not coincidental; it is systemic. And without honest engagement and decisive action, it will continue. This is why Wes Streeting was correct in making it his keynote speech yesterday at the RCOG World Conference. The Royal College of Obstetricians and Gynaecologists (RCOG), alongside the Royal College of Midwives (RCM), must remain central to this change. It is refreshing that the recent appointment of an Obstetrician, Alison Wright as the new President of the RCOG presents a critical opportunity for change. I believe that because of her experience and insight, there is now a renewed responsibility to deliver not only words, but tangible improvements in maternity care delivery, and the RCOG will become a driving force. The profession voted for her; Alison can deliver.
As health professionals we cannot continue to address this as though it were purely a ‘matter of management or policy.’ These issues are deeply embedded within our clinical practice and culture. That is why it is essential for all stakeholders – the Mothers, Obstetricians, midwives, the NHS and the Government to come together in an open, honest and solution-focused dialogue.
This conversation will need to go beyond blame, and seek to understand why these mistakes are still being made, why warning signs are still missed, and why some mothers and babies leave hospital permanently changed—(or tragically do not leave at all). Any national inquiry must also ask what structures, supports, and systems need to be put in place to make safe maternity care the norm, not the exception. The professions have little emotional support or time to reflect.
One of the most alarming consequences of this longstanding crisis is the spiralling cost of medical malpractice litigation. Year after year, maternity-related claims account for the highest value of clinical negligence pay-outs in the NHS. These are not ‘minor errors’; they are life-altering events—brain injuries, maternal deaths, neonatal and stillbirths-many of which could and should have been prevented. If we fail to address the ‘root causes’ of these incidents, the financial strain alone could become unsustainable for the NHS. The cost is not only measured in pounds, but in broken lives and lost trust from our patients.
We must also reflect on the nature of the care we provide. Beyond safety, maternity care must embrace empathy and be more humane.
Women and their partners need to be heard, respected, and supported throughout their pregnancies and births. The most effective clinical interventions mean little if they are delivered in an environment that is cold and hostile, and lacks empathy or fails to recognise the emotional and psychological needs of the mothers.
Our Royal Colleges together with NHS management and the Government need to engage and understand the concerns of the dedicated members and fellows and all the midwives to help to improve care. There is still time to act. But we must act together-and we must act now.
In 1960, my late father Norman Morris wrote in the Lancet ‘Midwives and Obstetricians have an especial responsibility for they are there at the beginning and it is probably the manner of the beginning that matters most of all.
