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Knowledge is supposed to be power as ‘they say’. Should uncomfortable knowledge be avoided? All women should read this article carefully. If you’re pregnant, particularly if you’re over 30 and expecting your first baby, there’s something crucial all such pregnant women in the UK need to know. A major investigation by The Sunday Times 09/11/2025 has just exposed widespread failures in how UK midwives are being trained.
Whether or not you agree our Fat Disclaimer applies
The problem isn’t your midwife’s dedication. It’s what they were taught at university. And it could affect whether pregnant women and their babies receive the right care at the right time.
Alex Barr – Poole Hospital, April 2020 (Sunday Times article):
- Almost 42 weeks pregnant
- Arrived at hospital with elevated heart rate and signs of bleeding
- Midwives dismissed her concerns and sent her home
- Hours later, at home in her car, she felt a rush of blood
- Her daughter Marnie was already dead
- Her repeated requests for induction had been refused
- After being told Marnie had died, she was forced to give birth naturally – her pleas for caesarean ignored “That was the most important thing to them. I felt bullied by the consultant. It felt like normal birth at all costs.“ [of a dead baby]
- The case exemplifies: dismissal of warning signs, refusal of reasonable requests, sending home a high-risk patient at 42 weeks, and prioritising natural birth even after the baby had died.
This is evidence-based opinion related to knowledge. Readers have choice – to know or not know.
What this isn’t
This isn’t about promoting caesareans. Many women have straightforward births without intervention. That’s excellent. The problem is bigger: it’s about midwives trained to avoid intervention even when it’s needed. It’s about warning signs being dismissed. It’s about requests for help being refused. The issue isn’t the birth mothers want – it’s whether the system will recognise when things change and act appropriately.
This is about culture and risk. Over two decades, investigations have revealed that dangerous cultures developed within NHS maternity services. Cultures where avoiding intervention became an ideology. Where midwives saw calling for doctors as professional failure. Where institutional targets for ‘normal births’ mattered more than individual safety. These cultures weren’t accidents – they were created through training, through targets, through shared beliefs about what ‘good midwifery’ looks like.
And here’s what matters: those cultures killed babies. The Ockenden Review documented 295 avoidable deaths or cases of brain damage at just one trust. Nine mothers died. Not because of individual mistakes, but because systemic failures created an environment where risks were normalised, warning signs were dismissed, and women’s concerns were ignored.
The investigations happened. NHS England changed its guidance. The Royal College of Midwives apologised. But the culture persists because two-thirds of universities are still teaching the same ideology that created it. New midwives entering the workforce carry these beliefs with them. The system claims to have learned, but the education pipeline continues to produce staff trained in outdated approaches.
This isn’t alarmist. It’s realistic. Most births will be fine. But “most” isn’t good enough when the difference is a baby’s life or brain function. Mothers are entering this system. Understanding the cultural failures that preceded them might be what keeps them and their babies safe. What mothers don’t want is anxiety. Well, it’s better to prepare now so that if complications arise anxiety is minimised. To avoid anxiety now is to court ‘shock horror’ later on, if in the odd chance it goes all pear-shaped.
Reality
Like it or lump it the uncomfortable reality: no mother can be confident about the quality of care she’ll receive when such powerful cultural influences operate across the UK. Sixty-five per cent of maternity units still need to improve safety. The cultural problems span multiple trusts, multiple regions, multiple decades. No mother can’t know whether their particular midwife was trained in one of the 66% of universities still promoting normal birth ideology. They can’t know whether their trust has genuinely changed its culture or simply changed its paperwork.
The Training Problem No One Talks About
A Sunday Times investigation published on 8 November 2025 reveals that 66% of UK universities are still teaching an ideology of “normal birth” that NHS England abandoned three years ago after a series of maternity scandals. This isn’t just an academic issue. It’s a training failure with real consequences.
The Ockenden Review into the Shrewsbury and Telford Hospital NHS Trust documented 295 avoidable baby deaths or cases of brain damage between 2000 and 2019. Nine mothers died. The report found that midwives were “overly confident” in handling complex pregnancies and showed a “reluctance to perform caesarean sections in order to preserve the Trust’s ‘normal birth’ figures.”
This wasn’t an isolated problem. Similar patterns emerged at Morecambe Bay, East Kent, and other trusts across England. The common thread? Midwives trained to prioritise avoiding intervention rather than recognising when intervention is needed.
Why This Matters More If You’re Over 30
The training failure has become more dangerous because pregnant women have changed. The average age of first-time mothers is now almost 31, compared with 26 in 1974. More than a quarter of pregnant women are obese. These women face higher risks and need more vigilant monitoring.
But midwifery curriculums haven’t kept pace. One student told investigators: “A lot of us are fresh out of college and the first thing you are told about is normal birth. Our job as midwives is to prevent what they call the cascade of interventions.”
Professor Marian Knight from Oxford University’s perinatal epidemiology unit said: “I can see evidence that midwives don’t have the training, the understanding, to manage women who are very sick because of the change in the characteristics of women who are giving birth.“
The Specific Failures You Need to Watch For
The investigations revealed recurring patterns in how things go wrong:
Dismissing warning signs: Alex Barr arrived at Poole Hospital at almost 42 weeks pregnant with an elevated heart rate and signs of bleeding. Midwives sent her home. Hours later, in her car at home, she felt a rush of blood. Her daughter Marnie was already dead. Barr’s repeated requests for induction had been refused.
Refusing reasonable requests: Women asking for induction or caesarean sections have had their requests dismissed or met with resistance. Some have been made to feel they’re “giving up” or not trying hard enough.
Delaying escalation to doctors: Hospital investigations found midwives reluctant to call for obstetric help, seeing their role as protecting women from medical intervention rather than collaborating with doctors when needed.
Missing critical timing: The Ockenden report found cases where ambulances weren’t called for 90 minutes when national guidelines require 10 minutes.
What You Can Do
Knowledge isn’t just power. It’s the difference between passive trust and informed vigilance. Here’s what protects you or someone you may know:
Understand your risk factors: Being over 35, obese, or having any medical conditions means you need more monitoring, not less. Being a first-time mother (primigravida) at 35 or older puts you in a higher-risk category that requires careful assessment.
Insist on proper monitoring: Your vital signs should be checked regularly using a Maternity Early Warning Score (MEWS) system. If your heart rate is elevated, your blood pressure is concerning, or you’re bleeding, these must be taken seriously and investigated. Not dismissed.
Know when escalation should happen: If you’re approaching 42 weeks, if you have any bleeding, if you notice decreased foetal movement, if monitoring shows concerning patterns – these require immediate senior review, not reassurance that “everything’s probably fine.“
Push back on dismissiveness: If a midwife dismisses your concerns, insist on seeing a consultant obstetrician. If they resist, be explicit: “I’m requesting to see a consultant. Please document that I’ve made this request and that you’ve refused it.” Documentation concentrates minds.
Trust your instincts: If something feels wrong, it probably is. Don’t let anyone make you feel you’re being anxious or difficult. Alex Barr knew something was wrong. She was sent home anyway.
Request written care plans: Ask for your care plan to be written down. What monitoring will happen? What are the triggers for intervention? Who makes the decision about induction or caesarean? Having this documented protects you.
Know your rights: You have the right to request a caesarean section even if there’s no medical indication. The NICE guidelines are clear on this. If you want one, you’re entitled to a discussion with a consultant who must take your request seriously.
The System Is Failing. You Can’t Rely on It.
Donna Ockenden, who led the major maternity investigation, said she’s hearing from student midwives themselves who are worried “that when they qualify, they will not be adequately prepared for the complexities of the women that they need to provide care for.“
Sixty-five per cent of maternity units in England still need to improve safety according to the Care Quality Commission. The Nursing and Midwifery Council has been criticised for poor monitoring of teaching quality. University midwifery departments are facing funding cuts and staff shortages.
This isn’t about blaming individual midwives. Most are dedicated professionals doing their best. But they’re working in a system with deep structural problems, and many were trained in an ideology that NHS England itself has abandoned.
Why Understanding the Culture Matters for Your Safety
You might think: “This is about systems and cultures. What can I do about that?“
Answer: Everything!
Understanding that this is cultural rather than individual means you know what to watch for. When a midwife resists your request for to be seen by a consultant, it’s not necessarily because your specific clinical situation doesn’t warrant it. It might be because they’ve been trained to see intervention as failure. When warning signs are dismissed, it’s not necessarily incompetence. It might be cultural normalisation of risk.
Understanding the systemic nature means you know not to rely on the system to self-correct. A culture where calling for doctors is seen as undermining midwifery autonomy won’t spontaneously produce staff who escalate appropriately. You need to force escalation.
Understanding that cultures are created through education means you recognise your care team may genuinely believe they’re doing the right thing even when they’re not. They’re not being malicious. They’re operating within a framework they were taught. But you don’t have to accept that framework for your care.
What You Can and Must Do
Knowledge isn’t just power. It’s the difference between passive trust and informed vigilance. Here’s what protects you:
Understand your risk factors: Being over 35, obese, or having any medical conditions means you need more monitoring, not less. Being a first-time mother (primigravida) at 35 or older puts you in a higher-risk category that requires careful assessment.
Insist on proper monitoring: Your vital signs should be checked regularly using a Maternity Early Warning Score (MEWS) system. If your heart rate is elevated, your blood pressure is concerning, or you’re bleeding, these must be taken seriously and investigated. Not dismissed.
Know when escalation should happen: If you’re approaching 42 weeks, if you have any bleeding, if you notice decreased foetal movement, if monitoring shows concerning patterns – these require immediate senior review, not reassurance that “everything’s probably fine.”
Push back on dismissiveness: If a midwife dismisses your concerns, insist on seeing a consultant obstetrician. If they resist, be explicit and assertive: “I’m requesting to see a consultant. Please document that I’ve made this request and that you’ve refused it.” The latter is no rude. Documentation concentrates minds. But don’t stop there, “I need to speak with my partner (or advocate) now. As I am in this condition, I cannot do much but they will be depositing a letter to your Chief Exec’s office within the next hour.” Of course such letter would have been drafted in advance with the assistance of AI, as ‘war room’ preparation. This is about your and your child’s life – you’re not being rude! You are fighting for the care you deserve.
Trust your instincts: If something feels wrong, it probably is. Don’t let anyone make you feel you’re being anxious or difficult. Alex Barr knew something was wrong. She was sent home anyway.
Request written care plans: Ask for your care plan to be written down. Mothers need to see this – you don’t have to be ‘medical’. What monitoring will happen? What are the triggers for intervention? Who makes the decision about induction or caesarean? Having this documented protects you and your baby. Go further: ask for copies or take photographs of the documents on your phone. No – they can’t have you arrested for doing that. It’s your information anyway. Invite them to call the police, if they want!
Know your rights: You have the right to request a caesarean section even if there’s no medical indication. The NICE guidelines are clear on this. If you want one, you’re entitled to a discussion with a consultant who must take your request seriously.
The System Is Failing:The Culture Persists
Donna Ockenden, who led the major maternity investigation, said she’s hearing from student midwives themselves who are worried “that when they qualify, they will not be adequately prepared for the complexities of the women that they need to provide care for.”
Sixty-five per cent of maternity units in England still need to improve safety according to the Care Quality Commission. The Nursing and Midwifery Council has been criticised for poor monitoring of teaching quality. University midwifery departments are facing funding cuts and staff shortages.
But the deeper problem is cultural. The Ockenden review found that the trust “failed to investigate, failed to learn and failed to improve.” This wasn’t about individual bad apples. It was about a system that created and maintained a culture where:
- Intervention was seen as failure
- Calling for doctors was viewed as undermining midwifery autonomy
- Women’s requests for caesareans were treated as anxiety rather than valid choices
- Warning signs were normalised rather than investigated
- Natural birth targets mattered more than individual circumstances
These cultures were built through education that taught normal birth as the goal, through institutional targets that measured success by intervention rates, through senior midwives who modelled resistance to medical involvement. And they persist because the same ideology is still being taught in two-thirds of universities.
This isn’t about blaming individual midwives. Most are dedicated professionals doing their best within a dysfunctional system. But good intentions don’t protect you from bad cultures.
The Uncomfortable Truth
The response to information like this reveals something about human psychology. We avoid what makes us anxious. We want to trust the system. We don’t want to think about things going wrong when we’re about to give birth.
But avoiding uncomfortable information doesn’t make you safer. It makes you more vulnerable.
The women whose stories fill the Ockenden report, whose babies died or suffered brain damage, weren’t less intelligent or less caring than you. They trusted a system that failed them. They didn’t know what questions to ask or when to push back.
You now know. What you do with that knowledge is your choice.
What the Regulator Is Finally Doing
In response to the Sunday Times investigation, the Nursing and Midwifery Council wrote to universities on 7 November warning them against promoting normal birth ideology. Paul Rees, the chief executive, demanded that all universities report back within a month on any courses deviating from NMC standards.
Health Secretary Wes Streeting said: “Every mother deserves midwives trained for the reality of modern childbirth, in the principles of modern maternity care – respecting women’s choice and individual circumstances – not an outdated ideal.“
That’s welcome. But it won’t help you if your baby is due next month.
Be Your Own Advocate – Have an Advocate
The most important thing you can do is approach your care with informed assertiveness. Not aggression. Not paranoia. But a clear understanding that:
- The system has documented failures
- Your midwife may have been trained in an outdated approach
- You have the right to escalation when you need it
- Being “difficult” might save your baby’s life
Ask questions. Demand answers. Insist on seeing senior staff if you’re not satisfied. Document everything. Trust your instincts.
Bring someone who can advocate for you. Your partner, a family member, a friend. Someone who can speak up if you’re in pain, distressed, or exhausted. Labour is not the time when you’re best placed to argue with staff. Having someone who knows your wishes and can insist on escalation if needed is vital. Make sure they’ve read this article and understand what to watch for.
The medical team should welcome an informed, engaged patient. If they don’t, that tells you something important about the quality of your care.
