Normal birth in the shadow of Morecambe Bay

Over the last year or so we seem to have reached a turning point in establishing evidence-based care that reflects the importance of supporting normal birth and a reduction of interventions, through choice of place of birth, and midwifery-led care. But the report of the Morecambe Bay investigation (Kirkup, 2015) appears to cast a shadow over this progress. It would be wrong if the response to the report were to set back the establishment of practice that will increase the overall safety of maternity services. Instead we need to establish safe practice and systems of care for all, whether midwifery-led or medical care is indicated.

The report is a harrowing account of poor outcomes and dysfunctional systems of care in one NHS Trust, that emphasised a ‘drift involving a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk’ (Kirkup, 2015: 183). This emphasis has been the focus of much of the commentary, without putting it into its rightful context.