Maternity report ‘changed to remove criticism of normal birth’

A senior investigator has resigned from a government-commissioned review into NHS maternity services, alleging that the final report was altered to remove criticism of a push for normal births. Dr Bill Kirkup, who previously led inquiries into maternity scandals at Morecambe Bay and East Kent, stepped down from Baroness Valerie Amos’s review over a dispute concerning “normal birth ideology”.

While Lady Amos stated in her review that her team “did not find that ‘normal birth ideology’ was currently widespread in the maternity services we visited in England”, Dr Kirkup strongly disagreed, advocating for a more robust stance. His own investigation into Morecambe Bay had previously concluded that midwives were pursuing normal birth without intervention “at any cost”.

Speaking to the BBC, Dr Kirkup confirmed that the removal of criticism regarding this practice from the Amos review ultimately led to his resignation.

“I don’t think it’s right that we should push this under the covers,” he said.

“This is a patient safety danger and I think it should be called out as such.”

He said investigators working for the Amos review had found evidence “that it was still an issue, at least in some places”.

He told the BBC that “a significant number of people” had signed off a version of the report that included criticism of normal birth but that eight days before its publication, “it disappeared”.

He said: “We ought to acknowledge that this is a problem, and that it’s got patient safety implications for mothers and babies.

“I think it needs daylight shining on it and then we can have a proper conversation about why this sometimes happens and how we make sure that it doesn’t keep on happening.”

Dr Kirkup said he would not discuss how the changes had occurred but that “I think she (Baroness Amos) has listened to the wrong voices on this particular issue”.

In 2017, the Royal College of Midwives dropped its “normal birth” campaign and removed advice for midwives from its website, following a backlash over the potential for unsafe care.

In 2022, NHS England also told hospitals to abandon targets aimed at limiting the number of Caesarean sections carried out, over fears for the safety of mothers and babies.

On Wednesday, NHS England published a letter from NHS chief executive Sir Jim Mackey to the NHS setting out how the recommendations from the Amos review can be implemented.

It said all trusts must commit to delivering safe and effective triage services, including dedicated midwifery staffing to answer calls from women and families and provide face-to-face assessments, separate from other services such as the labour ward.

Services should also have enough clinical, antenatal and bed capacity, with clear “escalation routes” in place at all times if women need more senior doctor review.

The 10-point plan came after an event with midwives, trust leaders and medical directors on Tuesday.

Sir Jim said in the letter “this must be a turning point for the NHS”, adding: “We cannot allow failures in care to persist and be followed by reviews that continuously highlight the same themes.”

Kate Brintworth, chief midwifery officer for England, said: “Too many women, babies and families have been harmed, bereaved or badly let down by maternity care, and too often women and families who raised concerns were not listened to.

“That must change – starting by giving every pregnant woman and new parent in England the comfort of knowing they will always have a midwife on the end of a call to answer their concerns if they are experiencing an emergency.

“This modernises maternity services so that pregnant women and parents who urgently need expert advice will no longer be left waiting for a call back or directed to a maternity unit voicemail – instead, they will get specialist advice straight away, helping them get the right care more quickly.

“I also know midwives need the time and space to carry out thorough risk assessments.

“By creating dedicated teams away from busy labour wards, we can support staff to make faster, safer decisions and deliver better care for mothers and their babies.”

Last week, maternity investigator Donna Ockenden published a report into 520 cases of avoidable harm and death at Nottingham University Hospitals NHS Trust.

She is due to chair independent reviews into poor maternity care at Leeds Teaching Hospitals NHS Trust and the University Hospitals Sussex NHS Trust.

The Government has responded to the Amos review by saying it will appoint the new national maternity commissioner recommended by Lady Amos to drive forward change.

Asked if she would take on the role, Ms Ockenden told Times Radio she “wouldn’t want to be a failure because of lack of time or lack of focus or effort by others who should be doing more”.

Asked about the substance of Lady Amos’s report, she said: “I don’t see anything that we didn’t already know, that hasn’t already been spelled out very clearly.”