Birth rates are falling, staff numbers rising, yet maternity services are at crisis point

Anatomy of Britain Review after review has shown NHS obstetric units are in turmoil as they deal with the problems of older mothers and a presumption towards ‘natural’ deliveries

- Martha Gill

There is a paradox at the heart of Britain’s maternity crisis. Other parts of the NHS are increasingly swamped as the population gets older and sicker. This should not be the case for obstetrics. Birth rates are dropping.

Meanwhile, the number of midwives and obstetricians has been rising for years. So how does reduced demand and increased supply end up landing us in a staffing crunch?

‘There is no doubt that UK maternity services are in turmoil. Nearly half of all English and Welsh maternity units were rated “requires improvement” or “inadequate” in inspections between 2022 and 2024. Maternal mortality has risen, newborn outcomes lag behind those of most high-income European nations and clinical negligence claims absorb £1.3bn annually.

All diagnoses of the NHS tend to involve the word “overstretched”. A recent review of maternity services by the Care Quality Commission, the health watchdog, is no different. “As demand for maternity services continues to increase,” the authors wrote, “the staffing levels need to keep pace with the changes to keep women and babies safe.” The review finds, for example, a single midwife “caring for 13 mothers and babies” on one postnatal ward.

But there is a contradictory story that runs alongside this, which is that units are closing for lack of customers. One in six has shut in the past decade ~ 31 of 190 maternity units in England and Wales, some permanent and some long term, Earlier this year it was announced that the unit at the Royal Free, in north London, would be closing, citing a low birth rate ~ the hospital remains open in the meantime. Areas of central London ~along with Cambridge and Brighton and Hove — have among the lowest birth rates (Barking and Dagenham’s is among the highest). But for England and Wales as a whole, numbers of births have dropped from 729,674 in 2012 to 594,677 in 2024.