Ensuring safer maternity care: Challenges, progress, and the urgent need for action
We are only a few weeks into 2025, but the year has already seen maternity safety in the UK media headlines.
At the beginning of the month, the UK government signalled its support for the House of Lords Preterm Birth Committee’s inquiry report, which pledges to reduce the incidence of preterm birth for babies and families. We have also seen new MBRRACE data showing only marginal reductions in maternal mortality in recent years.
It is, of course, right that the urgent need for maternity service investment and improvement remains in the spotlight. Whilst the UK remains one of the safest places in the world to give birth thanks to the commitment of NHS staff, the College recognises that every tragic outcome has a devastating impact on the affected families as well as the staff striving to provide the best possible care against a tide of challenges. I am also aware that every critical or upsetting announcement in the media takes its toll on all those working in maternity services and alarms women.
Clearly, the NHS is crying out for positive change and the NHS 10-Year Plan due later this year is an opportunity to deliver far-reaching, lasting benefits for the women and babies in our care. The College is using every avenue at our disposal to make the strongest possible case for maternity services and women’s health care to be central to the government’s plans. You may have seen my letter to the Health Secretary just this week urging against the removal of ring-fenced funding for Women’s Health Hubs, available on our website. We’ve been pleased to see from the NHS Planning Guidance that investment in improving maternity care will continue, but it’s crucial that the government considers the value of investing in women’s health in its entirety.
The College speaks on your behalf, and we want to keep hearing from you about what you need, what is working and what is not working, on the frontline. I am acutely aware that teams are working incredibly hard while contending against an unenviable host of challenges, including decades of underinvestment, staffing shortfalls, estates no longer fit for purpose and a lack of time to train, reflect or recharge. Every suggestion or experience you share helps us to paint a picture of the scale of the problem, as well as the compassionate, high-quality care that is provided every day to mothers, babies and families.
Last year, we asked members to Have Your Say on two maternity safety questions, and your responses have been hugely illuminating, with common themes and challenges being raised.
The results to date speak for themselves. Staffing levels come through as a top concern, with one obstetrician saying that their unit is “avoiding bad outcomes by the skin of our teeth”, and another talking about “constant firefighting and choosing the least bad option.” Others raised concerns about lack of trust in the maternity system, with women, particularly Black and Asian women and those from disadvantaged groups, not feeling safe, and in some cases, not having a safe outcome.
I was saddened, but unfortunately not surprised, that we heard from dedicated obstetricians who are considering leaving the profession because of current working conditions. Burnt out, frustrated by estates and equipment that aren’t fit for purpose, and sometimes on the receiving end of abuse from patients and colleagues, I was incredibly disheartened that one likened the state of maternity services in 2024 to working in the “Wild West”.
We will continue to post regular “Have Your Say” questions in 2025, and I encourage all our UK Members and Fellows to take a moment to feedback and encourage their colleagues to share their views.
Over the year, I will continue to visit maternity teams across the UK with Gill Walton, Chief Executive of the Royal College of Midwives, to listen to your experiences and concerns and really understand the challenges you face day to day.
What we hear from members drives our maternity safety programme, which will remain an absolute priority in 2025 for my officers and me. Ours is a rewarding, unique, special and specialist profession, one that brings new lives into the world every day and navigates the most intense highs and lows of human experience with clinical skill and compassion in equal measure. If we want to retain our excellent staff and combat deeply entrenched issues, the maternity system must work together and amplify the calls for action, investment and prioritisation from both the Government and the NHS, and the RCOG is fully committed to playing our role in this.
We’ll be building a strong case for the new Government to prioritise recruitment, retention and training in the maternity workforce, urging the DHSC to progress the Obstetric Workforce Planning Tool. The College completed the first phase of this project in 2023, and this tool has significant scope to advance our understanding of how to quantify, analyse and optimise obstetric staffing levels. While we have continued to advocate for further work, we continue to wait for news from DHSC on how it will fund subsequent stages.
This quarter will also see us bringing the third phase of the Avoiding Brain Injury in Childbirth (ABC) programme to a close, working with our partners at the RCM and THIS Institute. ABC is an incredibly important quality improvement programme, which aims to to improve and personalise maternity care and reduce the risk of two significant contributors to avoidable brain injury in childbirth. Following this successful pilot phase, ABC will be rolled out nationally by NHS England, to help ensure healthy outcomes for as many babies as possible. If you haven’t already, I’d highly recommend signing up for access to the ABC Clinical Network on Thiscovery, where you can see regular updates on this seminal project.
Addressing health inequalities in maternity services is something that I see as critically important; we must all play our part in understanding and acting on the factors behind poorer outcomes for Black and Asian mothers and babies, and those from disadvantaged backgrounds. I am hugely proud of our work with government and the NHS to address the higher rate of maternal mortality for Black and Asian women, informed by our own programme of work addressing racism and discrimination within the workforce, and we hope they will adopt recommendations from our latest policy position on this issue.
Working together and engaging closely with affected groups, I wholeheartedly believe we can take a step closer to ensuring that everyone accessing maternity services receives high-quality, personalised, and compassionate care, whatever their ethnicity, health profile, socioeconomic background, or location.
There is a huge amount of work ahead to champion our dedicated maternity teams, deliver quality improvements, and ensure that decision makers can implement the tangible, lasting changes that would make a huge difference to our workforce and the people in our care. But if we work together and continue to share experiences, celebrate success, and urge action where it is needed, I am confident that 2025 is the year we can turn the tide. For the future of our speciality and the women and girls that we look after, this is crucial.