What the Amos and Ockenden reviews mean for maternity and newborn safety (part two)

In part one of this blog, I looked at the case for a Modern Service Framework, the need to get triage right, the urgent need for action on health inequalities and the recommendation for a national maternity and neonatal commissioner. In this second part, I turn to care before and between pregnancies and to the workforce and funding challenge behind 24/7 consultant-level care.

Care before pregnancy and in between pregnancies

I am pleased to see pre-conception care recognised as part of maternity care, rather than treated as a separate service. Getting a woman's health optimised before she conceives makes a real difference to outcomes; relatively simple interventions can significantly reduce the chance of problems during pregnancy. This should also extend to the period after birth: contraception conversations and planning for a future pregnancy need to be a routine part of postnatal care, not an afterthought.

This matters most for women who have already experienced poor perinatal outcomes. Their risks in a future pregnancy can be higher, yet the desire to conceive again can feel immediate and deeply emotional. At the same time, physical and psychological recovery from the earlier experience may still be ongoing. Care needs to hold both these things at once: it must respect the urgency some women feel and give them the time and support they need. So often I see how the experience of one pregnancy influences the choices about care women make in the next and subsequent pregnancies.

The same expertise at three in the morning as at three in the afternoon

The call for 24/7 consultant-level medical care on labour wards is music to my ears. Women in labour at 3am deserve the same level of medical expertise around them as women in labour at 3pm.

But we also need to be realistic about the cost. Consultant-level cover, around the clock, every day of the year, is a significant investment. If we want this standard of care, we need an honest conversation about how it will be funded.

Cost aside, it will not be simple to deliver. We need to think hard about where this workforce comes from - it is not enough simply to increase staffing numbers. Previous efforts to expand the obstetric workforce quickly have sometimes meant clinicians recruited without the right skills or enough support or junior staff moved into senior roles before they were ready. In a system that is already stretched, this can create new pressures and new risks. Sustainable change means growing the workforce and investing in proper induction, mentorship, supervision, ongoing professional development and wellbeing support, so staff are equipped to deliver safe, high-quality care.

These reviews give us a genuine opportunity to reset how maternity and neonatal care is staffed and delivered in England. The recommendations are, in the main, the right ones. The real test now is whether the system can find the workforce, the funding and the sustained political will to deliver them, particularly on 24/7 consultant cover and dedicated triage teams. I will be watching closely and continuing to advocate for MNSI's investigations to hold a mirror up to the system. Progress should not only be demonstrated on paper. It should be felt directly by women and babies, particularly for those communities who continue to be disproportionately affected by inequalities.