Improving maternity services: change must be collective

UK maternity care is at a turning point after successive reviews into services locally and nationally. It has the opportunity to tackle the underlying drivers of failures and poor care. Many of these were identified in the recent review of Nottingham University Hospitals NHS Trust.1 They are systemic in nature—racism, lack of governance, failures in leadership, underresourcing, toxic workplace culture—but also clinical. In Nottingham, factors contributing to the many failures to escalate were not ideological but rather contextual and structural.Focusing on “normal birth ideology”2 as the root cause of failures in care takes attention away from the pressing systemic issues that must be tackled and denigrates the midwifery profession and physiological birth skills. Midwifery led models of care are recognised by the World Health Organization as proved, cost effective solutions to maternal and neonatal mortality globally.3 Continuity of care has an important role in the provision of safe, personalised care,…