The Medicalisation of Maternity Care.

It is doctors, not midwives, who now lead in maternity care services. So how is medicalisation going?

Throughout human history, delivering babies has never been an easy or straightforward procedure. In the process of giving birth both women and their babies have died in the process. Making comparisons about numbers and trends over the centuries is not an easy task.

          “In the 19th and first half of the 20th century, everybody knew about death in childbirth, particularly those women who were about to go through the process. Although death rates from many other conditions were high, they at least were among people who had been ill beforehand. Death in relation to childbirth was mostly in fit young women who had been quite well before becoming pregnant. They died, often leaving the baby, and other children in the family from previous births, with a widowed husband.”

This general understanding probably underscored the reason for the medicalisation of maternity services over recent decades. Childbirth is no longer led by midwives. Most babies are now delivered within a hospital settings overseen by doctors.

          “Over the past two decades, the landscape of childbirth in the UK has changed beyond recognition. From campaigns promoting physiological birth to scandals, safety inquiries, and a growing midwifery crisis, the role of the doula is now more vital than ever.”

A Guardian newsletter, dated 22 October 2026, ”The crisis putting maternity units in England at risk of closure”, has highlighted some of the problems that has resulted from the medicalisation process. It outlines staff shortages that are leading to the suspension and closure of some hospital in some ‘remoter’ areas of the country. The Guardian reported that up to 20 maternity units in England could close, and that “the story sheds light on a maternity care crisis that has been rumbling on for years”.

One reason the Guardian gives for this situation is the reducing birth rate, coupled with changing birthing practices.

          “More women than ever are now getting C-sections or having births that require medical intervention from doctors, and smaller maternity units are also grappling with a widespread lack of obstetricians.”

Indeed the rise of C-section births has been dramatic.

          “The proportion of births performed by caesarean increased from 31% in 2019 to 45% in 2024, and last year was the first time in England that more babies were born via c-section than “natural” births.”

The Guardian justified placing “natural” in inverted commas as it has become “a term that many women find pretty grating because it implies there’s a hierarchy between births with medical intervention and those without”. This in itself was a fundamental change in attitude. When my children were born in the 1970’s, ‘Natural Childbirth’ was in vogue, and my wife was part of this trend.

As a mere man, I became aware of the ‘struggle’ between midwives and doctors when my children were born, some 50 years ago now. If I recall correctly most births at that time took place at home, with the mother-to-be having regular access, for several months, to a midwife, who was in charge of the process, preparing the birth alongside the mother. Most births began and ended with this simple/natural process - although midwives always had access to medical advice and intervention as and when the need was identified.

Whatever the nature of the ‘struggle’ that has taken place over the intervening years it is clear that it is doctors in hospitals, rather than he midwives in the community, who now lead the birthing process. Why did this happen? It is easy to understand the medical justification - the assumption that ‘scientific’ medicine would soon be able to resolve the problems involved in giving birth. Medicine has made similar claims in many different areas over the last 100 years. 

• Vaccines have conquered infectious illness (sic). 

• Surgery is replacing failing organs and limbs (sic). 

• Pharmaceutical drugs were winning the battle against serious illness and disease (sic). 

So doctors would be able to improve the experience, and the outcomes of women giving birth. But as one midwife says:

          “I was a midwife watching as the tide shifted, as older midwives retired and as the new midwives came in, and I knew the blanket induction policy at 41 weeks would seal the fate of birthing women and people. A fate that involved induction of labour, medicalised and traumatising births often ending in a caesarean that they did not expect or want. I don’t personally believe it’s about money or Big Pharma. It’s a patriarchal medical model of pregnancy and birth that believes we are a machine that can be split into parts to be fixed and saved. Yet no one asked the women. Or the birthing people.”

So what has been the outcome of the medicalisation of maternity care? 

In September 2025 the UK government announced that 14 NHS Maternity Trusts were under investigation. Over the previous years the plight of so many NHS Maternity Trust’s has made regular headline news - even in the usually pro-medical mainstream media. So clearly, all is not well if the Guardian newsletter describes the broader picture as follows:

          “Some women are also worried about the type of care they might receive during vaginal births. Successive reviews portray a state of crisis, with burnt-out and exhausted midwives, a growing risk of serious injuries, and women of colour experiencing persistent racism and discrimination. A national review of maternity services in England from 2022 to 2024 by the Care Quality Commission warned that serious harm in maternity care risked becoming the norm”.

And all this with a considerable reduction in birthrates! So it has not arisen because of increased workload! 

A Medscape article, July 2026, stated that one in five women now needed emergency medical care. Discussing a Nuffield Trust report it said that more than 1 in 5 mothers (22%) needed emergency care in the year following the babies birth, the article outlining some of the salient features of emergency medical intervention in the early months following birth.

So as usual, the conventional medical establishment has failed to live up to the reputation it has routinely claimed for itself!

The National Maternity and Neonatal Investigation Report into the 14 hospital trusts was delivered in June 2026. It was a damning, describing the ‘toxic’ culture that now pervaded maternity services,. It highlighted many aspects of the problem. One key reason given for the rising rate of caesarean births is known as “defensive practice”, which arises when doctors make decisions in order to avoid blame or parental complaints, rather than doing what is necessarily in a patient’s best interests. The Health Secretary, speaking in the House of Commons, has highlighted this new “culture” that he said meant that when mistakes were made, maternity units prioritised their reputation over and above their duty of openness to families.

          “Culture is where so much of the responsibility lies. That culture is the most deep-rooted cause of the failures we have seen, and the most fundamental thing we must change”.

This is the medicalised culture that has developed over the last 50 years. It is rife throughout the NHS. The reports author, Baroness Amos, identified a host of other “shocking” failings in maternity care, including women being ignored, poor triage of mothers-to-be, putting lives at risk, and chronic understaffing of services.

The ‘old’ culture, based essentially on one mother, with one midwife, and the relationship they developed during the months of pregnancy, would perhaps have been a good antidote to all these problems but seems nowhere to be mentioned in the discussions now going on within health services.

According to the Guardian newsletter the cost of the ‘new culture to the NHS is huge, and rising. In order to settle outstanding maternity-related claims in England (alone) is estimated at £37.5bn in 2025. This is nearly two-thirds of the NHS’s £60bn clinical negligence liabilities bill, and the Guardian calculated that the bill for maternity negligence claims in England since 2019 could be more than the health service’s budget for newborns during the same period.

So I ask the question. Did these problems exist, or were they as bad in the pre-medicalised arrangements for maternity care? The old culture at least provided a structure for each woman that offered 1-1 support, friendship, and information about giving birth, including how much they wished the process to be medicalised.

When delivering any health service, my view is always that the best policy is to ‘follow the patient’, to be patient-focused, to provide as much information and support as possible to ensure that patients are making properly informed choices, and that their voice is clearly heard above the arrogant noise of the medical profession. Their science just does not deliver

Putting a huge medical bureaucracy in charge of maternity care, led by conventional doctors, is perhaps the worst possible direction that could have been taken; and it is time that we all began to realise this!