There is much being shared about the stress those in maternity services are experiencing, but also how they are not feeling listened to. Olga Lainidi, PhD Student and Post-Graduate Teaching Fellow, School of Psychology, University of Leeds, discusses the concerns and suggests how things could be different. She also invites us to participate in a study to help make changes going forward.
Maternity staff work long hours, in high-pressure environments, driven by commitment to mothers and babies. But that dedication is being tested by a system that leaves them carrying too much responsibility for its failings. On paper, the solution seems simple: staff should speak up whenever they see risks. But lived experience tells a more complicated story. In July 2024, nurses and midwives gathered outside the NMC to share harrowing testimonies of how speaking up left them unsupported or punished (Devereux 2024). The pattern is repeated across maternity care. In early 2025, a BBC investigation reported that midwives and doctors had raised concerns over and over again about unsafe care yet were ignored until tragedies forced action (Buchanan & Skarlatos 2024). Later the same year, it was revealed that whistleblowers in NHS pregnancy care were silenced rather than supported, illustrating the personal risk of speaking up (Bright 2025) .
When speaking up becomes unsustainable
I am not questioning the importance of speaking up for high standards of care – it saves lives. But when every single thing needs to be voiced, reported, and chased, it becomes unsustainable. The Ockenden Report (Ockenden 2022) makes this painfully clear: staff described raising staffing concerns “over and over” without adequate response, being told off for logging Datix incidents, and punished for escalating risks. More worrying still, many of the issues they had to push for are so fundamental and should not be requiring extraordinary effort to be heard: safe use of oxytocin, recognising abnormal CTGs, acutely deteriorating patients. These are some of the basics of maternity care, that can be raised and resolved in a safe environment.
We have enough evidence to know that constantly having to speak up is psychologically costly when systems don’t listen. For example, Freedom to Speak Up data (National Guardian’s Office 2024a) show a sharp rise in cases about worker safety and wellbeing, with bullying and inappropriate behaviours being common themes. NHS survey data also note stagnation in staff perceptions that it’s safe to speak up, risking disengagement (National Guardian’s office 2024b). When staff do persist, speaking up can be followed by serious mental-health impacts, including clinical levels of anxiety, depression, PTSD and increased suicide risk (MacLennan 2024). Just deciding what even “counts” as a voiceable concern in healthcare is cognitively and emotionally taxing – especially amid ambiguity, hierarchy, and normalised deviance – amplifying day-to-day strain (Dixon-Woods et al 2024). Remaining silent and having to withhold those concerns also drives moral distress and burnout across nurses and other clinicians. In maternity specifically, in a recent survey data report very high midwifery burnout and stress (Rey 2025), underscoring how chronic system pressures impact wellbeing. Is there really any way that staff in maternity care can act and not lose?
Speaking up alone is not enough
Both silence and the relentless demand to keep speaking up take a heavy emotional toll. Instead of being able to focus their energy on safe, compassionate care, maternity staff are left managing the psychological burden of a system that does not reliably hear or fix the problems they raise. Evidence from reports into failings of care (Ockenden 2022, Care Quality Commission 2024) shows that voice alone cannot carry the weight of systemic problems such as unsafe staffing, poor estates and entrenched inequalities. If every shift requires staff to raise the alarm about the same basic issues, the problem is not staff vigilance but a system that leaves hazards in place.
For every one thing a midwife manages to speak up about, there are likely ten more left unsaid. That is why silence is not the opposite of voice. And the more problems exist in a maternity environment, the more staff are forced to choose which concerns to raise and which to hold back. This doubles the strain: the stress of speaking up and chasing action, and the guilt or moral distress of staying silent.
Improving the system to support maternity staff
We need less silence as much as we need more voice. And the way to achieve both is not simply by urging staff to be braver; it is by reducing the things that need to be spoken up about in the first place. That means:
- Getting the fundamentals right: issues like the safe use of oxytocin, recognising abnormal CTGs, and escalating deteriorating patients should not depend on extraordinary effort or courage from individual staff.
- Reducing background noise: if staff are spending energy raising the same concerns shift after shift, they will be left exhausted. Recurring problems should be addressed so that maternity staff can focus on care, not constant firefighting.
- Normalising voice: speaking up should not feel like a battle against the system, but a normal and supported part of practice, with clear evidence that action will follow.
- Acknowledging the toll of silence: choosing not to raise an issue is rarely indifference; it is often survival, extreme burnout or rationing of emotional resources to deliver high quality care while fighting other battles.
When we talk about patient safety, the question is not just are staff speaking up? but also why must they speak up so much, and why is it so hard? What else is happening that they don’t feel they can share? The goal should be maternity services where midwives can raise concerns freely and where they don’t have to spend every day putting out the same recurring systemic fires. Until that shifts, we risk losing both the wellbeing of our staff and the trust of the families they serve.
I am not a midwife. I don’t work in healthcare. I am a psychologist and a researcher, and my PhD has given me the privilege of listening to healthcare workers, including maternity care staff talk about their daily realities, how they are dedicated to keeping mothers and babies safe. I say this not to distance myself, but to be transparent: I cannot know what it feels like to stand in your shoes. What I can do is share what I have heard and read, over and over, from those who do: that the way we talk about silence and speaking up often misses the real problem.
Every voice counts.
Help us shape research that reflects the realities of maternity care by joining our ongoing diary study. You can take part here: https://leedspsychology.eu.qualtrics.com/jfe/form/SV_dnh7cAPBWxHtNcO
Your time and experiences matter. Thank you for sharing both.
References
Bright, M. (2025) ‘Whistleblowers silenced over failings in NHS pregnancy care: Index investigates the culture of secrecy shrouding maternity services and women’s healthcare in England’, Index on Censorship, 14 April. Available at: https://www.indexoncensorship.org/2025/04/whistleblowers-silenced-over-failings-in-nhs-pregnancy-care/ (Accessed: 28th September 2025).
Buchanan, M. and Skarlatos, T. (2024) ‘Whistleblowers accuse NHS trust of avoidable baby deaths’, BBC News, 29 January. Available at: https://www.bbc.co.uk/news/uk-68094350 (Accessed: 28th September 2025).
Care Quality Commission (2024) What maternity services are like in England: Easy read version of “National review of maternity services in England 2022 to 2024”. London: Care Quality Commission. Available at: https://www.cqc.org.uk (Accessed: 28th September 2025).
Devereux, E. (2024) ‘Nurses share harrowing testimonies of NMC failures at protest’, Nursing Times, 17 July. Available at: https://www.nursingtimes.net/professional-regulation/nurses-share-harrowing-testimonies-of-nmc-failures-at-protest-17-07-2024/ (Accessed: 28th September 2025).
Dixon-Woods, M., Aveling, E.L., Campbell, A., Ansari, A., Tarrant, C., Willars, J. and Martin, G. (2022) ‘What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study’, Journal of Health Services Research & Policy, 27(2), pp. 88–95. https://doi.org/10.1177/13558196211043800
MacLennan, N. (2024) ‘The mental health effects of whistleblowing: Reflections on working with whistleblowers’, Mental Health and Social Inclusion, 28(6), pp. 1357–1369. https://doi.org/10.1108/MHSI-04-2024-0051
National Guardian’s Office (2024a) Speaking up data. Available at: https://nationalguardian.org.uk/learning-resources/speaking-up-data/ (Accessed: 28th September 2025).
National Guardian’s Office (2024b) Listening to the silence: Freedom to Speak Up in the NHS Staff Survey 2023. London: National Guardian’s Office. Available at: https://nationalguardian.org.uk/wp-content/uploads/2024/07/2024-NSS-2023-report.pdf (Accessed: 28th September 2025).
Ockenden, D. (2022) Final report of the Ockenden review: Findings, conclusions and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. UK Government. Available at: https://www.gov.uk/government/publications/final-report-of-the-ockenden-review (Accessed: 28th September 2025).
Rey, S. (2025) ‘Many obstetricians and gynaecologists suffer from burnout, survey suggests’, Imperial College London, 30 July. Available at: https://www.imperial.ac.uk/news/266813/many-obstetricians-gynaecologists-suffer-from-burnout/ (Accessed: 28th September 2025).
October 2025
Olga Lainidi
PhD Student and Post-Graduate Teaching Fellow, School of Psychology, University of Leeds
Email: o.lainidi@leeds.ac.uk