To improve maternity services we must confront the damaging ideology that prizes “normal childbirth” over safe care (BMJ, 29 June 2026)

Summary

This BMJ article argues that repeated failures in NHS maternity services—highlighted by the Nottingham review, which found hundreds of cases of potentially avoidable harm and deaths—cannot be explained solely by staffing, leadership or system pressures, but instead stem from a deeper cultural issue: an entrenched ideology that prioritises “normal childbirth” over safety. This mindset has led to patterns such as delaying interventions, discouraging women from seeking care early and failing to escalate risks, even when warning signs are present. The author suggests that clinicians often act according to what seems reasonable within their belief system (“local rationality”), meaning harmful decisions are shaped by training and culture rather than intent.