What the Amos and Ockenden reviews mean for maternity and newborn safety

Donna Ockenden’s Independent Review of Maternity Services at Nottingham University Hospitals NHS Trust and Baroness Amos's Independent National Maternity and Neonatal Investigation have both landed in the space of a few weeks. Between them, they set out the clearest picture we have had in years of what needs to change in maternity and newborn care. I have worked in maternity care for all of my career and these reports describe a system I recognise. This is the first of two blogs looking at what these reviews mean for the way we care for women, babies and families.

A framework that reflects how women actually give birth today

The recommendation for a Modern Service Framework is welcome and not before time. It reflects something I have watched change completely over my career. When I started, the majority of women had spontaneous, vaginal, midwife-led births. Today, over 60% of babies are born with some form of obstetric help, whether that is an assisted vaginal birth, induction of labour, or caesarean birth.

That is a profound shift in the nature of the work. It means far more women need obstetric input during labour, not just at the point of birth. Our intrapartum staffing models have not kept pace with this change. We need to plan our workforce around the births we are supporting now, not the births we used to support twenty years ago.

Getting triage right

Both reviews are clear that triage has been a weak point and I agree. This is not a new finding. Our own national learning report on midwifery units identified telephone triage as one of four recurring themes affecting maternity safety and it is a theme we continue to see across our investigations.

Maternity triage needs a dedicated team of midwives and obstetricians, working in a space designed for the job, with immediate access to neonatologists and anaesthetists when needed. Too often, triage has been staffed as an add-on to other duties. It should be treated as a safety-critical service in its own right, because that is exactly what it is.

Health inequalities: it is time for action, not more description

This is where I want to see much faster progress. Trusts and the wider system do not lack understanding of health inequalities in maternity and neonatal care. We have been documenting them for years. Our own work on this has consistently shown that the evidence of poorer outcomes for Black and Asian women and babies is both clear and longstanding.

What is needed now is decisive action, not further diagnosis of a problem that has already been exhaustively evidenced. If the Amos recommendations ask trusts to produce more detailed descriptions of their inequalities, rather than committing to specific, measurable and adequately funded actions to reduce them, that risks prioritising process over progress.

Women and babies experiencing these inequities need evidence that the system is prepared to act with urgency and accountability. The boldest recommendation is not to study these inequalities more closely, but to finally address them.

A commissioner: what matters is who takes it on

I welcome the recommendation for a national maternity and neonatal commissioner. What matters most now is who is appointed to the role. This needs someone with real credibility and the confidence of clinicians across the multi-disciplinary team, alongside a genuine understanding of what families experience when care goes wrong. A commissioner who is seen and trusted by the frontline, not just by government, is far more likely to see their standards implemented and to give this role the staying power it needs.

This is a two-part blog post. In part two, I look at the care women need in the years before and between pregnancies and at what it will really take to deliver 24/7 consultant-level care on labour wards, including the workforce and funding questions that come with it.