This article was published in the Sunday Times on 9 November 2025.
During my time as health secretary, nothing caused me more anguish than the repeated failures in NHS maternity care: the avoidable deaths of babies and mothers, the anguish of families who trusted the system and the reports that exposed the same cultural failings again and again.
Much work was done to address these problems but while baby deaths have fallen by around 20 per cent since 2013, it’s clear that more needs to be done. That is why I have strongly welcomed the appointment of Baroness Amos to lead a rapid investigation into maternity and neonatal safety, with the aim of creating a new national action plan and task force.
This work must confront one of the most sensitive but important problems of all. For decades, there has been a deeply embedded and often unspoken ideology that prioritises so-called normal birth (birth without medical intervention) over safe birth. Too often, this has meant ignoring warning signs, dismissing concerns and delaying vital intervention.
As health secretary, I vividly recall meetings with NHS England maternity leaders where I asked whether midwives were being encouraged to push too hard for “normal” births. The answer was always to play down the concern. But my own experience told me otherwise. At the births of my children, I saw how the NHS often steered mothers away from C-sections. This was despite growing evidence from inquiries that babies were dying because intervention came too late.
That mismatch was stark. It did not reflect what grieving families were telling me, what colleagues who had recently had babies were saying, or what independent experts later confirmed. The Morecambe Bay, Shrewsbury and Telford, and East Kent inquiries all reached the same conclusion. Pressure to avoid caesarean sections and to promote “normal birth” contributed to avoidable harm and loss of life.
In 2003, Shrewsbury and Telford was even held up in parliament as a model of best practice because of its low C-section rates. One midwife boasted that they recruited only “like-minded” staff who shared the focus on promoting “normality”. That was not a service focused on safety. It was one shaped by ideology. The consequences became devastatingly clear years later, when Donna Ockenden told MPs her investigation had found a culture of “normal birth at pretty much any cost”.
Yet today it is clear that elements of that culture persist. Thanks to campaigning families, the Royal College of Midwives dropped its “normal birth” campaign in 2017. But as recently as last year, NHS job adverts were still calling for midwives to “promote normal birth”. The language, and the thinking behind it, is still alive.
It is time to be honest. Birth is not a test of strength or a rite of passage. A mother’s worth is not measured by whether she avoids a spinal block or a C-section. What matters is what is safe.
The Amos review offers a once-in-a-generation opportunity to end this dangerous culture. That means reforming undergraduate training for midwives and doctors so safety and teamwork are at the heart of practice. It means teaching new professionals the hard lessons already learnt. It means never again having targets to reduce C-sections. And it means regulators, including the CQC, Nursing and Miwifery Council and General Medical Council, speaking with one voice.
This is not a criticism of the thousands of midwives, obstetricians and maternity staff who provide compassionate, skilled care every day. But it is a wake-up call to root out a damaging culture before more lives are lost. If we fail, mothers and babies will continue to pay the price.
