Maternity Safety Review Altered Before Publication, Expert Says
A review into maternity safety in England was altered just days before its publication to remove criticism of a "normal birth drive," according to a former member of the inquiry team.
The campaign, which promotes vaginal birth without medical intervention and is supported by many midwives, has been linked to avoidable deaths and harm in other investigations.
Dr Bill Kirkup told the BBC that similar criticism was removed from the government-commissioned review, leading to his resignation.
"I don't think it's right that we should push this under the covers," he said. "This is a patient safety danger and I think it should be called out as such."
When asked to respond to his remarks, Baroness Amos declined to comment.
Findings of the National Maternity and Neonatal Investigation Report
The National Maternity and Neonatal Investigation report was published on Tuesday.
Examining care across England, it found that women were repeatedly not listened to by maternity services.
One of its key recommendations—that the government appoint a maternity commissioner to drive improvements—has been accepted by ministers.
However, many campaigners were surprised that the review concluded that a "normal" birth agenda was not a contributory factor to poor maternity outcomes.
Background on the Normal Birth Campaign
Between 2007 and 2017, the Royal College of Midwives advised its members to encourage women to have vaginal deliveries without medical interventions such as pharmaceutical pain relief or forceps.
The organisation argued that such births were better for women and babies. However, this practice—sometimes encouraging women to remain at home when medical attention was needed or denying caesarean sections—has been criticised in several reviews as contributing to avoidable deaths and harms.
Writing last year, former Health Secretary Sir Jeremy Hunt stated that "the language, and the thinking behind it, is still alive."
Dr Bill Kirkup's Investigations and Resignation
Dr Kirkup chaired maternity reviews in Morecambe Bay and East Kent and found that the practice caused harm in both areas. His inquiry into Morecambe Bay found midwives were pursuing normal birth "at any cost."
Investigators working for the Amos review found evidence "that it was still an issue, at least in some places," he said.
He told the BBC that "a significant number of people" had approved a version of the report that included criticism of normal birth, but eight days before publication, "it disappeared."
Given the evidence, Kirkup felt compelled to resign.
"We ought to acknowledge that this is a problem, and that it's got patient safety implications for mothers and babies," he said.
"I think it needs daylight shining on it and then we can have a proper conversation about why this sometimes happens and how we make sure that it doesn't keep on happening."
Kirkup declined to discuss how the changes occurred but stated,
"I think she [Baroness Amos] has listened to the wrong voices on this particular issue."
Campaigners' Reactions and Historical Context
Maternity safety campaigner James Titcombe, who lost his son Joshua at the Morecambe Bay NHS Trust due to poor maternity care, has been a long-term critic of efforts to promote normal birth in the health service.
He said he was "utterly shocked" by Kirkup's claims.
"These events raise profound questions about the integrity and independence of the review process. Bereaved families deserve complete transparency," he said, adding that he felt "profoundly betrayed" by the Amos review.
Alongside the Royal College of Midwives' campaign, NHS England previously discouraged trusts from performing caesarean sections, encouraging them to limit such procedures to around 20% of births. This measure was dropped in 2022.
Support for the Review's Conclusion
Author and midwife Leah Hazard welcomed the review's conclusion.
Writing on social media, she said:
"The Amos review is out and it could not be clearer. There is no evidence that 'normal birth ideology' exists in any definable way or that it dominates maternity care in England."
She added:
"Let's put this debate to bed now and get on with what we all want: providing world class, safe equitable midwifery care."
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