My youngest baby is 21 years old. I became a doula at the same time. In my time working with new parents and seeing UK maternity services close up there have been a huge number of government investigations into the state of maternity care.
In 2010 Front Line Care was commissioned by Prime Minister Gordon Brown. This report examined the future of nursing and midwifery in England, offering 20 recommendations to enhance care quality and leadership.
In 2019 the NHS Long Term Plan outlined key priorities for the NHS over the next 10 years, including commitments to improve maternity safety, expand continuity of carer models, and reduce health inequalities.
In 2021 the Ending Preventable Deaths of Mothers, Babies and Children by 2030.This Approach Paper set out the UK’s global strategy to reduce maternal and child mortality, focusing on health systems strengthening, gender equity, and evidence-based interventions.
Also in 2021 the Parliamentary and Government Report, Safety of Maternity Services in England – Health and Social Care Committee Report was published. This inquiry assessed staffing, leadership, and patient safety in maternity care, highlighting systemic issues and recommending reforms. The Department of Health and Social Care responded to the committee’s recommendations, acknowledging areas needing improvement and outlining planned actions.
Another report in 2021 was the Expert Panel Evaluation of Government Commitments in Maternity Services. An independent panel evaluated progress on government maternity commitments, rating overall performance as “requires improvement.”
And then there have been the independent inquiries and reviews. The Ockenden Review in 2022 was an investigation into Shrewsbury and Telford Hospital NHS Trust examined 1,486 families’ maternity care cases, identifying failures in clinical practice and governance. The East Kent Maternity Services Investigation – Reading the Signals – also came out in 2022. This was led by Dr. Bill Kirkup and uncovered serious failings in maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust.
Better Births was commissioned by NHS England and was published in 2016
It was a National Maternity Review, chaired by Baroness Julia Cumberlege and outlined many recommendations:
- Make care more personalised, safe, and family-friendly
- Improve continuity of carer throughout pregnancy, birth, and postnatally
- Promote midwifery-led care where appropriate
- Strengthen multi-disciplinary team working
- Emphasise informed choice and women’s voices in decision-making
- Every woman should have a personalised care plan
- Greater access to midwife-led units and home birth
- Introduction of “continuity of carer” teams
- Creation of Local Maternity Systems to plan care locally
- Use of digital maternity records to improve information-sharing
First Do No Harm (2020)
Although not solely about maternity care, this report was also by Baroness Cumberlege and included important maternity-related content. The Report of the Independent Medicines and Medical Devices Safety Review investigated harms caused by:
- Primodos (a hormone pregnancy test)
- Sodium Valproate (an anti-epileptic)
- Pelvic mesh implants
Many women affected by these medicines/devices experienced birth defects, pregnancy complications, lack of informed consent and systemic dismissal of their concerns
Then there are the Surveillance and Audit Reports:
MBRRACE-UK: Saving Lives, Improving Mothers’ Care (2014–2024) These are annual reports analysing maternal deaths and morbidity across the UK, providing lessons to inform maternity care improvements.
Oh, and don’t forget the National Maternity Surveys (2006–2022). Conducted by the National Perinatal Epidemiology Unit, these surveys capture women’s experiences of maternity care apparently to inform service development.
The NHS Maternity Safety Support Programme was launched in 2017 and yet maternal death rates are rising. Women from Black ethnic backgrounds have a maternal mortality rate nearly three times higher than that of White women. Women from Asian ethnic backgrounds experience a rate almost twice as high as White women. Women living in the most deprived areas have a maternal mortality rate more than twice as high as those in the least deprived areas.
The Saving Babies Lives Care Bundle has resulted in a 19% increase in induction and a 9% increase in the cesarean birth rate, with the attendant risks to the physical and mental health of those birthing people and their babies. Whether it has had an impact on the stillbirth rate is up for debate.
Meanwhile, the humanitarian crisis in Gaza has critically impacted maternity care. Only five hospitals are currently providing maternity services across the entire Gaza Strip. Approximately 183 women give birth daily, often without access to midwives, doctors, or postpartum care. Many women have given birth without medical assistance and reports indicate some undergo C-sections without anesthesia. Malnutrition is rampant among children and pregnant women, with aid kitchens insufficient to meet the needs of over two million people. The UN estimates that nearly 71,000 children under five will suffer acute malnutrition in the coming year.
Sudan’s ongoing conflict has devastated its healthcare system, severely affecting maternal health services. Over 2 million babies have been born into the conflict over an 18-month period. Malnutrition among pregnant and breastfeeding women has reached alarming levels, with 1.2 million acutely malnourished as of March 2024. The quality of maternal health services has deteriorated, with many facilities lacking necessary equipment and supplies. Some healthcare workers lack training to provide adequate care, leading to increased maternal mortality and morbidity.
Afghanistan remains one of the most dangerous places in the world to be a mother or child. Access to hospitals or health facilities is beyond reach for many, and the country has one of the world’s highest maternal mortality rates, with 638 mothers dying for every 100,000 births. Only 6.2% of pregnant women receive good-quality antenatal care. The UN estimates that Afghanistan needs at least 18,000 additional midwives to meet basic maternal care needs.
Yemen’s prolonged conflict has devastated the health of women and girls. Women of childbearing age, particularly pregnant and lactating women, have limited or no access to reproductive health support, including antenatal care and safe intrapartum (labour and birth) care.
I’ve just returned from a trip to Turkiye. Just a short trip of five days yielded more stories to curdle the blood. My tour guide gritted her teeth, shed a tear and told me she would never have a second baby. After being given syntocinon her baby’s heart rate dipped alarmingly. She was told it was because the baby’s cord was around his neck. Anyone who works in maternity care will know that it’s highly unlikely this was the problem and much more likely it was the artifical hormone drip they put her on, without explaining why or telling her about any of the risks,that caused her baby’s distress.
A fellow hotel guest told me she withdrew her consent for a vaginal examination because it hurt. She told the midwife to take her fingers out and was ignored. In fact, the midwife said, “I AM EXAMINING YOU. USE YOUR GAS”. She was then declared “not in labour”, despite it being her second baby, her first was born in two hours flat and she could feel downward pressure. In spite of her protests, she was removed back to triage where she had her baby, minutes later.
As you might imagine, I’m simultaneously bored and traumatised listening to the same horror stories over and over again, seeing the same shameful statistics and watching maternity care crumble more and more, year after year. All this is made worse by the fact, neatly laid out in all these reports, that we know what’s wrong and we know how to fix it. We are in a maternity Groundhog Day, going round and around, over and over, having the same old arguments, shouting the same slogans, writing the same letters, on repeat, ad infinitum.
We know what’s wrong and we know how to fix it, yet they tinker around the edges, making bold claims and doing nothing.
Let’s look at that list of recommendations for improvements again. Almost all of them can be achieved with the help of doulas. We’re not the whole solution, by any means, but we can make a significant contribution.
Make care more personalised, safe, and family-friendly
(pretty much sums up doula care)
Improve continuity of carer throughout pregnancy, birth, and postnatally
(the whole point of the relationship-based care a doula offers)
Strengthen multi-disciplinary team working
(we love building relationships with health professionals when we are given the opportunity)
Emphasise informed choice and women’s voices in decision-making (
rights-based, client-centred working is at the heart of all we do)
Every woman should have a personalised care plan
(that’s what we work with our clients to create in our antenatal sessions)
Greater access to midwife-led units and home birth
(our role is to provide information to widen choice)
So what’s missing? Some might call it lack of money and resources. Others might blame a global pandemic, necessary conflicts, decreasing aid budgets or problems with supply chains and staffing. But what it really comes down to is a lack of political will, which is a polite way of saying they just don’t care enough.
I keep trying to figure it out, but the only explanation that makes any kind of sense is that they just. don’t. care. enough.
Around the world women and birthing people suffer from either too little medical support that may come too late or not at all, or too much foisted on us far too soon. We are told this is the way it has to be. We are sold promises that never materialise and we internalise the message that we are worthless, that our bodies are deficient, that birth is a dangerous nightmare to be endured and that our safety and satisfaction come at the bottom of the list, below profit and power.
Let’s be clear, whilst there are many wonderful people working in maternity care around the globe, the systems they serve and the governments that may, or may not fund those systems just do not have birthing people’s best interests at heart.
If we are to build a better future I think our only hope is to stop expecting someone else to rescue us, stop hoping governments will properly fund maternity care, stop thinking our leaders will send aid, fund NGOs and negotiate peace deals. We have to pick our fights, stand up, and start helping each other, in whatever way feels most in line with our personal passions, skills and talents, and according to our available energies.
Because if you accept that they just don’t care enough, the question to ask is, do you?
If you care and want to help and the idea of becoming a doula is calling you, check out our courses page for upcoming dates.
Maddie x
