Denise and her blog
The Parlous State Of The UK Maternity Services – Is Midwifery Education To Blame?
Sunday 9th November 2025 was a sad day for midwifery education in the UK with the publication in the Sunday Times of an article blaming universities offering pre-registration training of promoting an irresponsible “normal birth ideology”, apparently at the expense of safety for mothers and babies. Only a couple of weeks ago, the media bombarded us with the risks of home birth, following a case in which both mother and baby died. And now, the likes of Wes Streeting, Jeremy Hunt and of course James Titcombe, have waded in to the debate, taking the angle that midwives’ training programmes are to blame. This week, using the emotive case of a mother whose baby died at 42 weeks’ gestation, allegedly because she was not advised to have an induction for postdates pregnancy, the anti-natural-childbirth lobby has yet again found an excuse to launch another attack on midwifery, maternity care – and now – on midwifery education.
It is obvious that those determined to disparage midwifery and everything it stands for have no knowledge of childbirth as a normal bio-psycho-social life event nor of the dangers of the astronomical rates of intervention we are currently facing, across many westernised countries including not only the UK, but Australia, the USA and many European countries. There is no understanding of the World Health Organisation’s and International Confederation of Midwives’ definitions of midwifery and what constitutes midwifery practice, nor of their commitment to midwives as specialists in physiological birth. There is no comprehension of the role of the regulator (Nursing and Midwifery Council) in maintaining the international essential competencies for midwifery as promoters of physiological birth. And there is no empathy in failing to acknowledge parental emotions, desires or needs in this natural process of having a baby. Midwifery educator peers have been vilified (again) for daring to organise the annual Normal Birth conference, with the media – and those influencing the media – casting aspersions that this perpetuates the “ideology of normal birth at all costs”. Universities offering midwifery programmes have now come under fire for allowing this apparent dogma to thrive, with critics claiming that students are not being taught safe practice.
These critics – the policy makers, the politicians and influencers previously affected personally by birth related mortality or morbidity – have catastrophically failed to appreciate the multifactorial issues facing the maternity services, the midwifery and obstetric professions, midwifery education and all the other issues impacting on the dire situation we now face. We have a paternalistic antenatal and birth system that sees birth as a medical issue to be managed – and managed within the constraints of finances, staffing and bed space. We have an ever-increasing population with more women with complex pregnancies, often requiring intervention to achieve a safe birth. We have a maternity care system rife with bullying – of staff and consumers. We have a profession that is scared to step outside guidelines to support women safely and appropriately. We have such a focus on evidence-based practice that we are at risk of losing all common sense when it comes to birth.
There is an ageing midwifery workforce with many senior and experienced midwives retiring, sometimes taking early retirement to escape the deplorable maternity service environment. Conversely, we have students entering midwifery education with fewer prospects of jobs at the end because of an under-funded and inappropriately pathologised system. Crucially, students are not witnessing physiological birth in practice, nor are they observing experienced midwives prepared to advocate for normal birth out of fear of being accused of whistle blowing in an increasingly punitive system. Indeed, in defence of obstetricians, medical staff are also not seeing enough physiological labour and birth to be certain of their own boundaries, leading them to take a “just in case” approach, often intervening before it becomes necessary. Lack of experience, as a student or newly qualified midwife, of birth as a normal life event means that midwives are encultured into the medicalisation of birth, with many never developing the confidence to care for women in physiological labour nor the competence to recognise when labour deviates from normal progress and requires referral to obstetricians who specialise in “abnormal” labour.
Universities could be accused of being partly to blame for inappropriate education of midwives, but not in respect of evangelically promoting a normal birth “ideology”. Universities are businesses and need “bums on seats” to make their programmes cost effective. Shared learning has become standard in many higher education institutions – and not primarily because some shared learning is valuable, but because it saves money, time and rooming needs. My personal bugbear is the lack of anatomy and physiology that is now taught in midwifery pre-registration programmes (and sometimes not at all) – yet a deeper applied knowledge of A&P can save lives, both babies’ and mothers’. Midwifery educators are bound to comply with the international standards for midwifery, the UK standards for pre-registration education and to instil in students and qualified midwives the confidence in achieving and upholding the principles of midwifery practice, knowledge, understanding and progress.
Indeed, this whole debacle -accusing midwives and educators of promoting an “ideology of birth as normal at all costs” - smacks of yet another way in which the profession and expectant and birthing parents can be influenced. We have increasing numbers of parents petrified – not of giving birth, but of the maternity services in which they give birth. We have midwives who are terrorised by the ever-present threat of litigation. We have midwifery managers who have the constant sword of Damocles in respect of saving money whilst avoiding litigation hanging over them. We have a disjointed maternity service that is so embedded in the contemporary culture of fear, that no one is able to tie everything together for the good of all concerned.
It is time for midwives to fight – for our profession, our education system and most of all, for the women and babies in our care. We need to address the huge problems of an NHS that is no longer fit for purpose, especially in maternity care. We need to challenge the educational programmes for student midwives to ensure they can develop the confidence and competence to practise safely whilst addressing the full bio-psycho-social needs of people in their care. We need to challenge government to analyse the myriad issues faced by the maternity services – not in yet more service reviews, nor in simply throwing money at the system, but by changing the mindset of everyone to accept that childbirth – in the main – IS a normal life event. We need a better balance between spontaneous onset and progress of birth versus inappropriate or sometimes necessary intervention. And we need educational systems that ensure that both midwives and obstetricians can work together to provide the full spectrum of care that is effective, safe, cost effective, evidence-based where necessary and fit for purpose.
The media creates fear because fear keeps the population under control. And – make no mistake – this fear is male-driven. By this, I don’t mean only those biological men who are currently active in the debate, but our whole patriarchal society that puts women in a subservient position, something that has always been the case in relation to childbirth. And there, perhaps, lies the crux of the problem. We are not going to win the battle and be able to advocate for the midwifery profession and for childbearing women until we address the culture of childbirth more generally. The profession of midwifery is largely a female-dominated one, whereas traditionally obstetrics has been male-dominated. Even though that has changed, with far greater numbers of female obstetricians, they too have trained and practised in an autocratic medical system that persists to this day.
All that this current media scrutiny will achieve is to accelerate the climate of fear around childbirth, giving parents fewer choices and, in some cases, driving parents away from professional help, which may in itself lead to a whole raft of other problems. Whatever the media states, pregnancy and birth ARE normal physiological life events and midwifery is the profession best placed to help in that process.
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