Opinion: Baroness Amos’ Maternity Care report resists simplicity

Finito World

For more than a decade now, story after story has surfaced from maternity units across England, and each time the reaction has been the same: shock, apology, promise, review. And yet here we are again. Baroness Amos’s interim report does not describe a rogue trust or an isolated failure, but something more troubling – a system in which excellence and negligence sit side by side, sometimes on the same corridor, sometimes on the same shift. Safe care exists; she has seen it. But so too does care that is patchy, inconsistent, and, for too many families, catastrophic.

What is striking is not simply the catalogue of failings, but their familiarity. Capacity pressures that hollow out antenatal services. Delivery units stretched to the point where community midwives are redeployed and safety margins shrink. Buildings so outdated they compromise clinical dignity. Bereavement spaces that are either inadequate or absent altogether. These are not new revelations. They are the slow drip of a system that has known for years that it is running too close to the line.

But this report goes further. It names something that has often been whispered and too rarely confronted directly: racism and discrimination embedded within the culture of maternity care. Asian women described as “princesses”, as though pain were melodrama. Black women characterised as having “tough skin”, presumed able to endure more, and therefore heard less. Muslim families fearful that raising concerns might rebound upon their child. Disabled women, refugee women, LGBT families reporting marginalisation. Structural inequality is not an abstract policy phrase here; it translates into markedly higher risks of adverse outcomes. When stereotype enters the delivery room, it does not stay rhetorical for long. It shapes who is listened to, whose pain is believed, whose anxiety is dismissed.

Then there is the matter of relationships inside the system itself. “Poor relationships” between obstetricians and midwives; bullying and racist behaviour by senior clinicians left inadequately challenged by management. Healthcare, at its best, is a choreography of trust – between professional and patient, but also between professional and professional. When those internal relationships fracture, the consequences are rarely contained. They ripple outward, into decision-making, into escalation, into whether a concern is voiced or swallowed.

Again and again, families return to a single, devastating refrain: we were not listened to. Robyn Davis’s son, Orlando, died at fourteen days old after staff failed to recognise that she had developed hyponatremia during labour. An inquest found neglect had contributed. Her husband Jonathan speaks of a culture in which professionals assume they know better, forgetting that the one person continuously inhabiting the body in question is the mother herself. It is a simple point, almost embarrassingly obvious, and yet it cuts to the core. When compassion and transparency falter, when harm occurs and is met not with openness but defensiveness, trauma compounds. Mothers blame themselves. Lessons go unlearned.

The political choreography now begins. Wes Streeting has promised action when the final recommendations arrive in April. A maternity taskforce was pledged; it has yet to materialise. Campaigners fear another “damp squib”, another high-level review that gestures at reform without gripping the deeper levers – including the regulators themselves, who sit outside the current scope. Some families are calling for a full statutory inquiry, arguing that only the gold standard of accountability will suffice for losses that are irreversible.

The temptation in moments like this is to retreat into binaries: the NHS is broken; the NHS is heroic. Baroness Amos resists that simplicity. She speaks of good, even excellent care co-existing with the unacceptable. That coexistence may be the most unsettling finding of all. It suggests that the knowledge of how to do this well already exists within the system. The question is not whether safe maternity care is possible, but why it remains so unevenly distributed – by geography, by ethnicity, by class, by the internal culture of a particular trust.

Maternity services sit at the point where policy becomes flesh and blood. They are where the state quite literally meets the citizen at their most vulnerable. If racism, poor teamwork, under-staffing and crumbling infrastructure are allowed to persist here, they are not marginal flaws; they are signals about what we are prepared to tolerate. The test for April will not be whether another document is published, but whether the country decides that bringing a child into the world is an arena in which inconsistency is no longer acceptable.