Globally the birth of Jesus Christ is celebrated at Christmas time. It brings into sharp focus again how much wonder and awe there is about birth. In an article written to his colleagues at Liverpool Women’s NHS Foundation Trust, Andrew Weeks, Consultant Obstetrician and Professor of International Maternal Health, University of Liverpool reflects on the nativity and reminds us all of the importance of the role we all play in the significance of birth and that it is something to celebrate.
Over Christmas time we hear a lot about maternity. We sing heartily about birth, the newborn child and the celebration of bringing new life into the world. It’s wonderful that each year we have such a powerful reminder of the importance and significance of birth. And we should feel very lucky. No other medical specialty has its own annual festival. The colorectal surgeons don’t get one, nor do the dermatologists. Maybe the cardiologists come closest with Valentine’s Day – but even this has to be shared with colleagues in ER, surgery and psychiatry when we see images of arrows through hearts and broken hearts.
This Christmas, from my perspective, the celebration of maternity had a slightly hollow ring about it. Over the last year there has felt to be so much pressure and media anxiety around maternity services, that it seemed odd to be celebrating. Some of you may have seen my recent academic article on the perfect storm facing maternity services. In that article I try and put together the reasons why multiple factors have come together to produce stresses on maternity right now. It is not only the legal changes which allow women to choose their preferred mode of birth throughout pregnancy and labour, but also anxieties around litigation, national maternity reviews, and the CQC inspections. All have come together over the last few years to hugely increase pressure on midwives, doctors and managers. The greatest stress of all is on pregnant women and their partners who understandably become hugely anxious about what they hear about ‘worsening care’ within maternity services. It is no great surprise that we have developed a very low threshold for birth by caesarean section – for women it provides a sense of control, whilst doctors gain some protection against litigation and criticism. Other women respond by opting out of standard NHS care pathways all together.
The sadness is that this new ‘crisis’ presented in both the media and by campaigners does not fit with the reality. All of us who work in maternity services know that care for women and outcomes for babies are improving all the time – but this is rarely mentioned by the media. For example, national stillbirth rates have reduced by 17% since 2015. Also, the recently published CQC maternity survey shows general satisfaction with the overall experience of care, with many indicators improving over time. Depending on the specific question, around 8-9 out of 10 postnatal women state that they were satisfied with the care they received whether it is in advice received, being treated with care and compassion, or being involved in decisions about their care. Sadly, for each of these responses there remain a significant minority who are not satisfied and a key issue for us is how to make sure that we can make the experience as a good one for all.
So, what is the ‘crisis’ about? Birth trauma, the issue at the root of many families’ concerns, has always been an issue in maternity care but has largely not been a topic of public discussion. There have always been women and babies who have had bad outcomes after childbirth, and one of our roles has been to support them through this. I would like to think that most of us are skilled at being alongside families during difficult births and working with them postnatally to come to terms with their experiences. However, it is clear from the stories in the press that there are many who have not felt supported in this way and feel let down by the UK maternity system. It is critical that we address this and ensure that all women feel supported and cared for by maternity services, whether their outcomes are good or bad.
It’s very easy when you at the centre of a media storm like this to feel under threat and unappreciated. However, as we move into the New Year, we should take a moment to remind ourselves of the good that we do – both as individuals and as a system. There is no room for complacency, but in my global health work I see many other maternity settings around the world, and I can tell you that the care we provide in the UK is the envy of most. And to achieve this despite the restricted NHS budgets is truly remarkable. So, as we come back to work after the Christmas break, we should take time to think positively about all that we do.
To end this piece, I tried to find a short religious passage that would appropriately describe wonderous births. However, sadly, the medical records of Jesus’ birth are not of today’s standard. Despite St Luke being a doctor, the gospel writers appear to be more interested in the newborn’s clothing, crib and postnatal visitors (and their gifts) than on the critical issues of cord clamping and perineal care. Nevertheless, the Christmas story does serve to remind us of the huge significance of birth in people’s lives; we should be proud of all that we do to ensure that it is not only safe but also a wonderous experience for all concerned.
January 2026
Professor Andrew Weeks, Consultant Obstetrician, Liverpool Women’s NHS Foundation Trust, Professor of International Maternal Health, University of Liverpool
This article was previously published in the Staff Support Briefing for Liverpool Women’s NHS Foundation Trust