This commentary examines the National Maternity Review (Better Births, 2016) from the perspective of midwives, obstetricians and other professionals providing maternity care.
It draws on the review’s evidence base, including the National Perinatal Epidemiology Unit (NPEU) analysis, and subsequent public reports and data up to 2026. It is commentary and research synthesis only.
It is not clinical guidance, training material or professional advice.
Clinicians must follow current national guidance, local protocols, their professional regulator’s standards and their clinical judgement in individual cases.
Introduction
The 2016 review was grounded in extensive engagement with front-line staff as well as women. It recognised the dedication of maternity professionals while identifying the pressures under which they worked: rising birth numbers and complexity, workforce strain, poor data systems, variable team working across professional boundaries, and a culture in some units that did not consistently support open reporting and learning.
Core recommendations for practice
Personalised care and informed choice
The review called for every woman to develop a personalised care plan with her midwife and relevant professionals. This was not intended as an administrative exercise but as a way of ensuring care reflected the woman’s values, circumstances and decisions.
Clinicians were expected to provide unbiased information on options, including place of birth, and to support women to make decisions and change their minds as circumstances evolved.
The NPEU evidence commissioned for the review found that midwifery-led models for low-risk multiparous women were associated with fewer interventions and no evidence of worse neonatal outcomes.
For low-risk nulliparous women, planned birth in midwifery units or at home was associated with fewer interventions but higher transfer rates and, for home birth, a small increased chance of adverse outcome.
These findings informed the emphasis on offering genuine choice with clear discussion of benefits and risks.
Continuity of carer
The recommendation for every woman to have a midwife in a small team of 4–6 providing continuity across the pathway was central. The review argued this would build trust, improve safety through better recognition of deterioration, and enhance the experience for both women and staff. Implementation has required new models of working, including community-based teams with links to obstetricians for advice and referral.
Multi-professional working and training
The review stressed that those who work together should train together. It called for multi-professional learning in pre-registration programmes and as part of continuing professional development, covering both routine and emergency situations. Electronic maternity records were recommended to support information sharing, with women able to contribute to their records.
Safety culture, data and learning
Safety assessments showed wide variation. Under-reporting of incidents was common in some units; higher-reporting units tended to have stronger learning cultures and better team working.
The review recommended board-level maternity champions, rapid referral protocols, consistent data collection focused on meaningful indicators, and a national standardised investigation process when things go wrong.
It also supported systems of rapid resolution and redress to encourage openness.
Postnatal and perinatal mental health care
The review identified historic under-investment in postnatal care and perinatal mental health. It called for appropriate resourcing so women could access their midwife (and obstetrician where needed) after birth, with clear pathways for longer-term follow-up and transition to primary care and health visiting.
Implementation challenges and the current position
Workforce pressures have been a consistent theme in subsequent reports. Midwives and obstetric trainees have reported higher levels of work-related stress and feeling unsupported compared with some other NHS staff groups.
Implementing continuity at scale requires sustainable staffing, appropriate skill mix, and organisational support. National data show wide variation between trusts in the proportion of women placed on continuity pathways.
Data quality and burden remain concerns. The review noted that too much data of questionable relevance was collected, often incompletely. Later reports have continued to highlight problems with the timeliness and accuracy of maternity data, which affects the ability to benchmark and improve.
Safety culture has improved in some units but remains inconsistent. Subsequent inquiries (Ockenden x 2, Kirkup, and the 2026 Amos investigation) have repeatedly identified failures of escalation, poor communication between professionals, and defensive or closed cultures in some settings.
These findings indicate that the cultural and relational elements emphasised in Better Births have proved harder to embed than structural changes such as dashboards or care bundles.
Postnatal care continues to be identified as a relative weak point. Handover to primary care is not always robust, and women with medical conditions or mental health needs arising or exacerbated in pregnancy may not receive seamless ongoing management.
Implications for clinical practice in 2026
Clinicians working in maternity services are operating in an environment of heightened national scrutiny, multiple overlapping recommendations from inquiries, and ongoing workforce challenges.
The evidence base supports relational models of care – continuity where achievable, personalised discussion of options, and team-based working that crosses professional boundaries.
Practical priorities consistent with the review’s findings include:
- Using personalised care planning conversations to understand what matters to the individual woman, including her preferences, concerns, and any pre-existing health or social factors.
- Working within multi-professional teams, with clear escalation pathways and mutual respect for different professional perspectives.
- Contributing to and using data for local improvement rather than solely for external reporting.
- Supporting women’s informed choices within a framework of safety, with honest discussion of the evidence for different birth settings.
- Paying particular attention to the postnatal period, including mental health screening, feeding support, and effective handover.
- Maintaining openness when things do not go as planned, participating in learning reviews, and supporting families through explanations and, where appropriate, apologies.
The NPEU evidence and later evaluations indicate that midwifery continuity models can deliver benefits for many women when implemented safely and with appropriate governance.
They also highlight the need for flexibility – for example, in entry criteria to alongside midwifery units for women with some complications who still wish to pursue a midwifery-led approach with specialist support available.
The clinician’s position in a changing system
Better Births was written at a time when the legal and policy direction (including the Montgomery judgment of 2015) was moving towards greater emphasis on individualised consent and patient partnership. The review aligned with that direction.
Subsequent experience shows that delivering relational, personalised care at scale requires more than policy statements; it requires sustainable workforce models, supportive leadership, and organisational cultures that prioritise understanding the woman in front of the clinician over compliance with process alone.
Many clinicians entered maternity care because they wanted to provide exactly the kind of woman-centred, safe care the review described. The challenge has been creating the conditions in which that is consistently possible.
The 2026 Amos investigation’s findings on culture, leadership, workforce support and listening to families suggest that these conditions remain unevenly present.
Mandatory disclaimer
This article is for general information and discussion only. It is not medical or legal advice, nor a substitute for professional advice. To contribute evidence, ideas, or corrections, please email womenshealthproject@outlook.com. Please do not share personal data when emailing. Individual cases cannot be reviewed.
This project does not offer any form of legal service and cannot assist with complaints, claims or individual advocacy. This platform is independent and not affiliated with any law firm, regulator, inquiry or clinical body.
© 2026 Women’s Health Inquiry Project (WHIP). This article includes original analysis of material from publicly available national sources. It may not be reproduced without permission.
References
- National Maternity Review, Better Births (2016) and supporting NPEU evidence review.
- RCOG Clinical Indicators and workforce data.
- RCM analysis of NHS Staff Survey responses from midwives.
- MBRRACE-UK confidential enquiries.
- Baroness Amos, National Maternity and Neonatal Investigation (2026).
- Ockenden and Kirkup maternity reviews.
- NHS England Maternity Transformation Programme progress reports and workforce strategy documents.
- Published evaluations of continuity of carer models and Saving Babies’ Lives Care Bundle. All sources are publicly available. This is interpretive commentary, not clinical advice.