Nothing less than radical whole-system change is required to fix the NHS's maternity services | Julia Sanders

It is hard to find the words to describe the agony for those who have experienced preventable baby loss, injury or maternal death. Understandably, families who have been through this have campaigned relentlessly for local and national investigations. Every family deserves to know what caused their loss or trauma, but current and past reviews have failed to deliver on resolution and accountability.

The vital debate about how to ensure safe maternity care has intensified since the publication of two reports, led by Valerie Amos and Donna Ockenden, and the appointment of Yvette Cooper as secretary of state for health and social care, offering a golden opportunity for system-wide change. “I want to make it a personal crusade to put the cradle back at the heart of the NHS,” Cooper told the Guardian last week, adding that she was committed to introducing a new national maternity commissioner.

For women and families, cumulative systemic problems have resulted in failures of compassionate care, with distressing examples described in both reports. Where behaviour is unkind or unprofessional, this is inexcusable, and the life-changing physical and psychological trauma caused by poor care must continue to be acknowledged.

We also owe it to all staff groups, particularly midwives, who are often blamed in the media, to recognise that they provide high-quality care to many women every day, despite intense workplace pressures. The Amos inquiry found that just 22% of midwives reported having sufficient time to do their job well, while a Guardian report last month highlighted increasing numbers leaving the profession because of burnout.

Undermining and villainising midwives helps no one. They are the only professional group working with women, babies and families throughout the entire maternity journey across hospital and community settings, providing the platform on which other services depend. For women and babies to be safe, all staff must work in supportive, well-managed and adequately resourced environments.

The public criticisms of maternity services over the past decade suggest poor care is common, but regular national surveys by Oxford University report high and relatively stable rates of overall satisfaction with care between 2006 and 2024. Poor outcomes do not necessarily equate to poor care. The Ockenden review included over 700 maternity cases with poor outcomes, including stillbirth, severe perineal trauma or major haemorrhage among more than 41,000 births between 2020 and May 2025. In over 80% of cases, care was judged to be in line with best practice, or it was considered that different management would not have altered the outcome.

Work from the Neonatal Data Analysis Unit at Imperial College London found that the number of babies born at term with brain injury caused by oxygen deprivation declined between 2015 and 2021, and stillbirth rates have fallen. These are important gains, but reports from the National Perinatal Epidemiology Unit at Oxford University show that in 2022-2024 the overall rate of maternal death in the UK was 20% higher than it was in 2009-2011 and the Amos inquiry also found persistent inequalities, overt racism and continuing reports of physical and psychological trauma.

Piecemeal initiatives have produced unintended consequences. Attempts to improve safety and maternal choice have been accompanied by rapidly rising obstetric intervention rates. NHS data shows that labour induction increased from about 20% before 2010 to more than 34% by 2020, before slightly reducing. Caesarean section rates rose from 27% of births in 2016 to 45% in 2025, equating to about 100,000 additional caesarean births annually compared with a decade ago.

Focusing on interventions as the solution to maternity safety risks displacing resources and overlooking a fundamental component of maternity care: women need more than technical interventions. Some need to be held safely through loss. All need skilled care, information and trusting relationships with their maternity team. Relationship-based midwifery continuity of care is proven to provide positive outcomes – but few women currently receive this.

There is a risk that political, professional and media debate will deflect attention from the central priority: delivering safe and equitable care based on robust evidence and genuine partnership with women and families. The Amos inquiry concluded that nothing less than radical whole-system change is required.

This must be grounded in two key shifts. First, a fundamental reset of the relationship between services and women and families, to ensure that women, families and frontline staff have real influence over how services are designed, delivered and monitored. Second, decisions must be guided by evidence on effectiveness, cost-effectiveness, women’s experiences and sustainable implementation.

The national maternity and neonatal taskforce, to be chaired by Cooper, has been challenged to deliver the recommendations of the Ockenden review and the Amos inquiry. It must be bold enough to redefine what NHS maternity services can and should provide and negotiate for the resources required. Strong commitment and accountability from politicians, NHS boards, regulators, professional leaders, educators and every member of the multidisciplinary team will be essential. The future health and wellbeing of our population requires nothing less.

• Julia Sanders is professor of clinical midwifery at Cardiff University and was an expert adviser to the national maternity and neonatal investigation led by Valerie Amos