Not long ago, I watched as a heavily sedated mother surfaced from unconsciousness. Exhausted, disoriented, rubbing her eyes — slowly, then all at once, she discovered that her newborn baby had a life-altering illness. Inside that room with her, the father swallowed back his grief and his rage at a system which had failed him. Like many other men utterly powerless as their partners and children fight for their life, he trusted that pregnancy and childbirth were “sorted” in modern Britain, that complications belonged to Victorian novels, not contemporary NHS wards.
The headlines announcing a £27.4 billion bill for NHS maternity failures likely shocked most readers. This staggering sum, accrued since 2019, represents legal compensation paid out for clinical negligence. Freedom of Information data reveals that families pursuing legal action against the NHS for obstetric errors reached nearly 1,400 cases in 2023 — double the 2007 figure. As an NHS doctor, however, I find nothing surprising in these numbers.
Our maternity culture, which sees one in 20 women develop PTSD from their birth experience, has deep-rooted issues. Too often concerns raised by women during medical emergencies are dismissed as “hyperbole” or “first-time parent anxiety”. But many medical complications are, in fact, preventable: cerebral palsy can result from delayed caesarean-sections and brain damage comes from oxygen deprivation. Sometimes, if the staff had listened to their patients, the unimaginable could have been avoided.
So while the media bemoans “wasted taxpayers’ money” and even my own colleagues roll their eyes, it’s only right that the NHS should face enormous compensation bills. The mother has to contemplate lifelong support systems for her baby: specialised equipment, endless therapy, home modifications, and round-the-clock care. Individual payouts by the NHS can reach millions, but legal damages aren’t punitive, they reflect the cold arithmetic of catastrophic care needs. The financial calculation must account for the costs of her child’s care, not just now — but for the next 70 years. The money offers no comfort; these families would surrender every penny to have their child’s health back.
But why does maternity care fail so catastrophically? And so frequently? Among medics, there is a subconscious bias that pregnancy and childbirth don’t count as “serious” medicine. This contributes to research gaps, funding shortfalls, and career disincentives. Obstetrics and gynaecology struggle to attract top talent partly because they’re perceived as less prestigious than male-dominated specialties. Consequently, men are largely absent from discussions about birth safety, pain management, and systemic improvements.
“There is a subconscious bias that pregnancy and childbirth don’t count as serious medicine.”
This prejudice plays out in hospital hierarchies. There’s often a toxic dynamic between obstetric departments, typically led by male consultants, and midwifery services, predominantly female. Professional jealousy results in dangerous power struggles and communication breakdowns. Obstetricians look down on midwives as quasi-medical practitioners; midwives resent doctors who swoop in to “medicalise” natural processes.
Women in labour, and their families, pay the price for these ego battles. Many times, I’ve witnessed emergency cases where crucial decisions were delayed because departments couldn’t communicate effectively. A simple conversation might have prevented disaster.
Maternity care has been designated a “women’s issue”, not just in the medical field but within families themselves. Despite men being 50% responsible for every pregnancy, the assumption seems to be that women will handle the messy business of reproduction and will deal with the fallout when things go wrong. When I encounter families grappling with these failures, women invariably emerge as the primary caregivers. They’re the frequent visitors — worn-down mothers, their faces etched with quiet resignation.
The impact on fathers, meanwhile, is underestimated. When medical disasters strike during labour, men often describe feeling completely powerless — watching their partners suffer while being excluded from decision-making processes they barely understand. Unlike mothers, who are at least acknowledged as primary victims, fathers become invisible casualties, expected to simply cope with trauma and life-changing circumstances. Forced into playing the tough guy who must “get over it”, many men abdicate responsibility both emotionally and practically.
I’ve treated men who have developed severe anxiety and depression following birth complications, who blame themselves for not advocating more forcefully, who carry guilt about their inability to protect their families.
Among these discussions, the question is often raised: would the same level of systemic dysfunction persist if men gave birth? I think we can safely say the answer is no. If patients were male, if men faced excruciating pain followed by potential lifelong disability from medical errors, the entire system would be recalibrated. Men tend to take institutional failures personally. They demand explanations, seek accountability, and won’t tolerate being fobbed off with patronising reassurances.
Yet sexism alone doesn’t offer the full explanation. In 2022, the Ockenden review, an independent investigation of maternity services at Shrewsbury and Telford Hospital NHS Trust, was published. It found that targets to avoid caesareans left 300 babies dead or brain-damaged and contributed to 12 maternal deaths. The culture in Shropshire promoted abstract ideals of “natural” birth over actual safety.
In the UK, we have an obsession with “natural” birth, and this has created a moral pressure that literally kills. Remember the “too posh to push” hysteria that followed Victoria Beckham’s caesarean in 1999? The implication was clear: women who needed medical interventions were somehow failing at their biological destiny. By 2009, senior midwives were publicly declaring that “more women should be prepared to withstand pain”. This wasn’t evidence-based medicine, it was Victorian morality dressed up in modern scrubs.
A second major Ockenden review into maternity services at Nottingham University Hospitals reported painfully similar findings to Shrewsbury and Telford. Since then, many more trusts have been subject to extreme concern. And in June this year, Wes Streeting announced a “rapid” national inquiry into NHS maternity services across England.
The path forward requires uncomfortable conversations about medical hierarchies, professional territorialism, and yes, ingrained sexism within healthcare. We need standardised protocols that prevent communication breakdowns along with better training in collaborative care — and swift consequences for the kind of professional tribalism that puts patients at risk.
More fundamentally, we need to recognise that reproductive health isn’t a niche concern, but a central healthcare issue affecting entire families and communities. The £27 billion bill isn’t just about compensating individual tragedies: it’s an indictment of systematic failures that we have tolerated for far too long.
Maternity failures are the responsibility of everyone within the NHS, not just those working directly in obstetrics. The most dangerous words any medical professional can utter are: “That couldn’t happen in my department.” The maternity reviews so far have shown us that these problems can emerge anywhere — from provincial hospitals in Kent to major teaching units in big city centres.
Every one of the £27 billion compensation cases represents a family whose life has been devastated by preventable failures. Behind the financial figures are parents who will spend decades providing care that should never have been necessary, and siblings who will grow up with responsibilities no child should bear.
The key question is whether we have the courage to confront the uncomfortable truths about how gender, power, and professional hubris continue to undermine patient safety in one of medicine’s most fundamental areas. The £27 billion price tag suggests we can’t afford to shy away.
