Maternity care in the NHS in shocking failure

A damning interim report has revealed widespread failures in NHS maternity care due to discriminatory attitudes and staffing issues. These issues are then compounded by a lack of accountability for those same failures.

On 23 June 2025, health secretary Wes Streeting announced an independent, national investigation into NHS maternity and neonatal services. Valerie Amos, a Labour member and baroness of the House of Lords, is chairing the inquiry.

NHS maternity care failings

In an interview on BBC Breakfast this morning Amos stated that:

I have seen bad, poor, good and excellent care co-existing side by side.

Families have described to me good experiences, terrible experiences. It is patchy, it is inconsistent and what this investigation is about, is trying to find out the things that move us from poor and bad to good and excellent.

I am able to say categorically that there is safe care. There is good care, I have seen examples of it. But, I have also seen way too many examples of poor care.

What I have heard from families it is so traumatic and distressing. I have seen Trusts that have changed their practices as a result of what has happened in those trusts. It is a very mixed picture. It is not consistent.

Amos structured her findings around six key areas:

Capacity pressures
Culture and leadership
The quality of estates
The workforce itself
Racism and discrimination
Poor responses and lack of accountability when things go wrong

Capacity, culture, and quality

A lack of capacity on the wards meant that important services were delayed or stopped altogether. Practitioners had to rush through antenatal appointments, leaving inadequate time for meaningful discussion.

Likewise, there were also long delays for medical assessment, admission onto delivery wards, and even planned caesarean sections.

Beyond this, issues in organisational culture also led to striking shortcomings in experiences of pregnancy, childbirth, and postnatal care.

The report detailed instances of a lack of teamwork and cooperation between maternity and neonatal teams, with disastrous effects. Similarly, Amos also described instances of poor behaviour – bullying, racism, and failing to do their jobs – from senior clinicians not being dealt with.

Further, the increasing complexity of maternity and neonatal services has also created staffing issues, even in spite of recent staffing increases and decreasing birth rates.

The interim report noted that this was particularly noticeable with services like bereavement and breastfeeding support, which were sometimes cancelled due to being out-of-hours.

With regard to the estates, some maternity and neonatal services were delivered on outdated and dilapidated premises. This, in turn, compromised the quality of clinical care. Issues included cold wards, leaking roofs and a severe lack of space.

However, Amos also stated that even some modern estates were misaligned with clinical needs, including a lack of bereavement areas or space for non-birthing partners.

Racism and discrimination

The interim report was damning in terms of structural racism, discrimination, and inequalities causing a “notably higher risk of adverse outcomes” for Black and Asian parents, as well as people from deprived areas. Similarly, it also detailed discrimination against disabled people, Muslims, refugees, asylum seekers, and LGBT individuals.

This discrimination against racialised parents is hardly new information. However, Amos has shed light on just how little improvement there has been in this regard, reporting that:

Babies of Black ethnicity are more than twice as likely to be stillborn, and are at increased risk of preterm birth and neonatal admission at term when compared with White babies. Neonatal mortality rates are also higher for Black and Asian babies compared with White babies, and there is variation in neonatal care delivery between ethnic groups.

Similarly, both maternal and neonatal mortality rates for families from the most-deprived areas in England were more than double those of their least-deprived counterparts.

Stereotyping from clinical staff was also a frequent issue. Black patients reported being treated as though they were tolerant to pain due to their “tough skin”. Meanwhile, Asians were stereotyped as “princesses” who were too demanding and unable to handle pain.

Disappointingly, Amos also showcases the very discrimination she’s highlighting. The interim report states that:

LGBTQ+ families reported a lack of inclusivity, with some reporting that services focus narrowly on “mothers” and “fathers” and fail to reflect diverse family structures. One family member said “I almost died in birth, as I had my baby – I was then asked questions like ‘who was the real mum?”

In spite of this cursory acknowledgement, Amos nevertheless frequently refers to birthing parents solely as ‘women’ throughout the report. This attitude serves to further alienate trans people who are already experiencing discrimination during pregnancy.

Accountability and cover-ups

Along with this litany of failings in NHS maternity and neonatal services, Amos also called out a lack of accountability in the aftermath of incidents of harm.

This included reports of a lack of transparency around what had actually occurred in the instance of birth trauma and baby loss. Families reported being kept out of investigations, and that the inquiries were often arbitrary and unfair when they did happen.

In the event of a bereavement, families also reported that staff were reluctant to talk about what actually happened. This perceived refusal to admit wrongdoing meant that families thought a coverup was taking place. One patient reported that:

I’d initially requested my medical notes on paper format. What I have on paper doesn’t also match what they sent electronically. So I can see the amendments made. There is a lot that are redacted.

Some parents also reported ambiguity as to whether their baby had been born alive before being recorded as stillborn. Again, this led to accusations of staff trying to bury evidence of failures. One bereaved family member stated for the report that:

you register a baby as stillborn, you have no investigation, an independent investigation. […] The bereavement midwife came with [name]’s stillbirth paperwork and gave them to me. I said, “[name] was not stillborn, he was neonatal”. And she said, “Well, this is what he’ll be registered as, and if you don’t register him as stillbirth, you won’t be able to have a funeral and you won’t be registered anywhere”.

Next steps

This interim report comes ahead of the full review, which Amos will publish at a later date. Before then, you can still contribute to the evidence until 17 March 2026. Follow this link to the National Maternity and Neonatal Investigation Call for Evidence.

This includes two different surveys. One for people who have been pregnant to share their experiences. The other is for other people – non-birthing partners, friends, family or caregivers – to share their experiences supporting someone through pregnancy.

After Amos makes her recommendations, the health secretary will chair a National Maternity and Neonatal Taskforce to put them into action.

However, given that Streeting has demonstrated his commitment to gutting health spending at the expense of patient care – as well as being dedicated to the same bigotry that the interim report called out – we’re not going to hold out breath for improvements in NHS maternity and neonatal care.

Featured image via the Canary