The dangerous cult of natural birth
Ella Whelan looks at the cultural changes needed to make NHS maternity care fit for purpose. PLUS: join us at the Ideas Matter residential school, The Academy.
The state encroaches ever more into our lives, yet its institutions are crumbling. From the police to healthcare, the civil service to defence, vitally important functions are not being delivered. This apparent paradox – increasing authoritarianism aligned with organisational disintegration – is the theme of The Academy, the annual residential school organised by Ideas Matter. This year’s event takes place on Saturday 22 & Sunday 23 August at Wyboston Lakes. You can find out more below.
In this essay, Ella Whelan offers a case study in one particularly tragic arena, NHS maternity services, which have seen far too many unnecessary deaths of mothers and babies in recent years.
In the years between 2012 and 2025, at least 156 babies and six mothers died in the care of maternity staff at Nottingham University Hospitals NHS Trust (NUH). Donna Ockenden’s long awaited Independent Review – out late last month – heard from over 2,500 families who had suffered the tragedies of poor care at the trust. Despite these staggering figures, just four of the 14 senior leaders and 35 of the 66 senior managers at Nottingham agreed to speak to Ockenden’s review.
This is not just a scandal, it’s a nightmare. Otherwise healthy babies died because they were not given the most basic levels of care, from monitoring of heart rates and movement to ignored signs of distress. Excited pregnant women and new mothers were left to die because they were ignored when they complained about pain or bleeding. Hundreds more were wounded or negatively affected by disastrously poor levels of care both before, during and after birth.
Anyone who has had a baby in the UK knows how it goes with the NHS - you’re given your blue book and filled with promises of how ‘bespoke’ and ‘personal’ your birth is and how much ‘control’ you have over what takes place. You’re invited to peruse the options of pool, home birth or the various suites at the hospital, asked what playlist you might like to listen to, and made to believe that your every whim and fancy will be accommodated on that special day. Anyone who has had a baby also knows that this is a fantasy – a lie, even. Once the baby arrives, the blue book becomes a joke book, and you are at the mercy of whoever is on duty. At Nottingham University Hospital, women didn’t just have their musical choices disregarded, but were ignored by staff when they reported a dip in foetal movement or were showing signs of increased blood pressure and distress – all potentially fatal signals.
Ockenden’s review is a success in some ways – not least because it was forced and fought for by immensely brave women and families who, while still suffering through their grief, have demanded answers to why their children and loved ones died. It lays out clearly the scale of poor care and the attempted cover-ups by senior staff in Nottingham who knew that there were serious issues in maternity care for decades. The government has promised to review Ockenden’s findings and come up with a plan, and has ordered rapid reviews of other trusts. More scrutiny and investigation of these matters is a good thing – there are families all across the UK who cannot find peace until those responsible for their losses are held accountable.
But the review also has its limits. Some maternity safety campaigners, like Emily Barley – whose daughter Beatrice died at Barnsley Hospital in May 2022 – are calling for a judge-led statutory inquiry which would force reluctant staff in Nottingham and other trusts to come forward.
Emily Barley was a panelist on our 2024 Battle of Ideas festival debate: The politicisation of maternity. You can also listen to this session on the Battle of Ideas Audio Archive here.
Despite the reviews, investigations and reports, we seem to be no closer to understanding why so many staff at so many hospitals across the country failed to deliver babies safely, despite working in a modern, Western nation which has had the medical and scientific means to reduce infant mortality in birth for many years. Ockenden’s report pointed to staff shortages, high turnover, bullying within the management team and other familiar NHS complaints. None of this provides a meaningful explanation as to why so many women are reporting either negative or fatal consequences when it comes to having babies in UK hospitals.
It’s also true that it is becoming harder to trust any conclusions made by investigations or reviews, when a cover-up culture seems so prevalent in many NHS trusts and in government. Baroness Amos was instructed by the government to undertake a rapid review into maternity services, published as the National Maternity and Neonatal Investigation on 30 June. But what made the headlines wasn’t the unsurprising levels of bad care that Amos underlines, but the fact that the final report had erased any mention of ‘natural birth’ from its findings. Dr Bill Kirkup, one of Amos’s expert advisers, even stepped down from his role in protest of the removal, arguing that there were significant concerns about natural-birth ideology in maternity services, and the removal of the words ‘natural birth’ from the report betrayed that fact. Never mind the usual NHS staffing issues – this is where so much of the problem with maternity services lies, in a dogged denial that a fashion for ‘nature knows best’ is encouraging midwives to play a hands-off role in maternity care.
If it’s taboo to criticise NHS staff, who are used to applause and charity campaigns, it’s really taboo to criticise midwives. And yet, I think it’s time to go there. There are too many cases to ignore featuring poor or biased decision-making by midwives who seem to be committed to the singular goal of preventing medical intervention in birth. In her review, Ockenden points to the fact that NICE guidelines have long told midwives to ‘encourage her [mother in labour] to remain at or return home’ and that ‘delaying admission until active labour could reduce the likelihood of medical intervention’. Is it any wonder, then, that at Nottingham University Hospital, midwives used the acronym ‘FOH’ to send women in labour away – to “f*ck off home” – a directive that inevitably put women at risk of giving birth without the presence of a doctor or midwife?
We’ve been discussing maternity care for well over a decade - watch this film from our Battle Archive of 2014 Battle of Ideas festival debate: Baby on board: the battle over pregnancy.
There is ample evidence to suggest that midwifery has undergone something of a ‘woo woo’ transformation, with interference from charities like UNICEF guiding staff to encourage knackered mothers to exclusively breastfeed. If you thought Stonewall had an unhealthy foothold in the NHS, you would be shocked about the influence organisations like the National Childbirth Trust have in healthcare decisions, often based on little or no scientific evidence. There is also a clear dislike of caesarean sections and a celebration of women labouring and birthing vaginally with no pain relief. Some midwives even favour water injections and aromatherapy to help with the discomfort of contractions. Midwifery is turning from cold, hard scientific fact towards a different, earth-mothering trend. We’ve been here before. Mothers of the past were forced to rely on women waving bags of herbs and magical assurances – many of them died.
If we are to get some real answers as to why things have become so bad with maternity care, there can be no sacred cows. Even those of us who left the hospital with our babies alive have stories to tell. I remember coming to after an emergency c-section with my first child, listening to my midwife arguing with my anaesthetist that I didn’t need any morphine. Being hooked up to a machine would have meant more faff for the staff overnight. Thankfully, he put his foot down and, if I hadn’t been half comatose, I would have leapt up and kissed him.
We have modern tools and methods to make childbirth (fairly) painless and safe. So, why are we turning away from them? Why is the idea of women labouring, struggling and risking their wellbeing become the norm? C-sections are on the rise, women are voting with their feet. Most of us don’t want to leave things up to chance or nature when it comes to the arrival of our precious children. For the sake of all the women and babies we’ve lost and all the ones yet to come, the cult of natural birth needs to be investigated, understood and eradicated. Maternity care needs to get back to basics if it is to be fit to care for women in the twenty-first century.
Ella Whelan is a co-convenor of the Battle of Ideas festival and a columnist for the Telegraph.
THE ACADEMY 2026:
HOLLOW LEVIATHAN – THE STATE AGAINST THE DEMOS
SPEAKERS INCLUDE:
Frank Furedi ● Chris Bayliss ● Lola Salem ● Andrew Fox ● Tim Black ● Paul Lay ● Nicholas Tate ● Jacob Reynolds
CURRENT PROGRAMME
WHAT IS THE NATIONAL INTEREST?
Frank Furedi executive director, MCC Brussels; author, In Defence of PopulismCOMING APART: AUTHORITARIAN STRATEGIES FOR
A FRACTURED SOCIETY
Chris Bayliss contributing editor, The CriticHOLLOW MILITARIES AND REAL SECURITY
Andrew Fox writer, commentator, former paratrooper; co-host The Brink podcast; author, Andrew Fox SubstackWHAT REMAINS? ART AND MEMORY IN THE POST-CULTURAL STATE
Lola Salem Oriel College, Oxford; author, Artless (Polity, forthcoming); contributor, The Critic, Engelsberg Ideas, TelegraphISLAMO-LEFTISM AND THE ROOTS OF
CONTEMPORARY THIRD-WORLDISM
Tim Black books and essays editor, SpikedECHOES OF THE ENGLISH CIVIL WAR?
Paul Lay senior editor, Engelsberg Ideas; author, Providence Lost: The Rise and Fall of Cromwell’s Protectorate; co-host, 1666 and All ThatTHE BOOKS THE ELITE NO LONGER READ – BUT SHOULD
Nicholas Tate educationalist, commentator, author, What is Education For? (2014) & The Conservative Case for Education: Against the Current (2017)
Today’s state is a sprawling leviathan. It reaches into our lives to an historically unprecedented degree. Yet it is, at the same time, fragmenting, incompetent and unable to maintain control of safety and security, internally or externally.
Beyond this, something is missing: any sense of legitimacy. Political legitimacy in the modern era is conferred by the people – the demos – yet the contemporary state often appears to be set explicitly against them. Ordinary people are seen as a problem to be managed, a source of danger, as something for the state to be protected from.
The Academy 2026 will explore the origins and development of the contemporary state. Why is the state, which seems to be growing inexorably, apparently incapable of delivering? Is it increasingly set against the people – and if so, why?
Discounted early-bird tickets are available until Monday 20 July. For full details and ticket options, click the button below.