I'm a midwife - and here's my "ideology".

Last week, Jeremy Hunt stated that “normal birth ideology is killing babies” (The Times, 2025).  A bold statement - and a dangerous one. He cited several inquiries (Morecombe Bay, Shrewsbury and Telford, East Kent, Ockenden), and while it is true that these reports discussed a misplaced culture of promoting normality, that was only one factor amongst a sea of failings that have not received equal attention in the media.

Those same reports repeatedly highlighted unsafe staffing levels, inadequate training and clinical supervision, lack of resources, toxic workplace cultures, and failures of management around candour, investigations and learning after mistakes were made. Instead of focusing on fixing those deep-rooted systemic failings within maternity services, Hunt once again chose to fearmonger and demonise midwives, claiming we hold an ideology of “normal birth at almost any cost”.

He is right to be concerned about the avoidable harm that continues to affect women and families across the UK - but he is wrong to place that blame at the feet of the midwives who  work tirelessly within the constraints of underfunded services, bound by policies and guidelines set far above their heads, in an environment that often works against them at every turn.

Where this midwife ideology accusation falls short

When the NHS itself defines a midwife as an “expert in normal pregnancy and birth” (NHS, 20200, and the Nursing and Midwifery Council state that a midwife’s role includes “optimising normal physiological processes” (NMC, 2019), why is it such a scandal that this is exactly what midwives are doing every day?

Midwives don’t dogmatically oppose intervention; There is no blanket rejection of medical intervention, nor glorification of “normal” birth. We understand, optimise and protect physiology with everything we have when it is working, and we recognise, escalate and seek obstetric support when it’s not.

“Normality” and “physiology” are not dirty words to be censored from the language of birth, nor concepts to be used as scapegoats every time the NHS maternity services fail another family. They are the foundations of midwifery - and there is an overwhelming amount of evidence that shows midwifery models of care saves lives and improves outcomes significantly (Sandall et al, 2024; Renfrew et al, 2014;  WHO, 2024). For a midwife to safely recognise and act upon situations that deviate from what’s expected, they need to have a solid understanding, and a healthy amount of respect for physiology - this is not “ideology”, it is biology, autonomy and expertise.

The real problems in maternity services

Over half of maternity units today in the UK have a safety rating of either “requires improvement” or “inadequate” (CQC, 2025). The largely ignored workforce and resource constraints continue to drive poor outcomes: underfunding, understaffing, poor escalation and investigation pathways, lack of training and toxic workplace cultures all lead to a lack of risk recognition, delays and harm. Blaming “normal birth” for these failures not only misdirects attention from these important root causes, it erodes public trust in midwives (who are highly skilled healthcare professionals), fuels fear of birth and continues to perpetuate the outdated idea that women’s bodies are inherently unsafe and require controlling.

The word "normal"

In 2017, the Royal College of Midwives removed the term “normal birth” from its publications - not as a rejection of physiology but as a response to the repeated and continued misuse of the term by the media (Sandeman, 2017). Yet here we are, years later, with journalists and politicians still weaponizing the phrase to portray midwives as reckless extremists, hell bent on women having vaginal births no matter what.

So perhaps it’s time to ask - what even IS normal?

By definition, “normal” means “the standard or the common type”. If that’s the case, then it might surprise people that the most common way a baby is born in the UK today is not via spontaneous vaginal birth but is actually via caesarean or instrumental delivery (NHS Digital, 2024).

If you look deeper into the statistics, you’ll find:

• The rate of spontaneous onset of labour has dropped from 62% to 42% since 2013-14.

• The rate of induced labour has increased from 25% to 33%.

• The rate of caesarean birth before labour has increased from 13% to 25% in the same time frame (NHS Digital, 2024; NMPA, 2025).

And yet, despite the sharp increase in intervention rates, outcomes for mothers, birthing parents and babies are not improving (MBRRACE-UK, 2023).

If midwives are truly so fixated on promoting normal birth “at any cost”, why do more than half of all births in the UK now involve medical intervention? Are we just that bad at pushing our sinister agenda, or could it be that there is actually no widespread “normal birth” ideology and politicians just want to stir up public disdain for midwives to cover up their own professional failings?

For what it's worth...

I'm a midwife - and here is my "ideology". I believe that:

• All women and birthing parents deserve balanced, relevant and evidence-based information so that they can make informed choices about their care, free from judgement, coercion or fear.

• Informed choice should be prioritised, supported and respected - regardless of whether it follows guidelines or not.

• Birth IS a profound, transformational rite of passage.

• Midwives must deeply understand physiology in order to recognise any deviations into pathology and escalate as necessary.

• Physiological processes can be supported in any clinical context if the birthing parent consents. Optimising physiology does not mean rejecting medical intervention.

• Maternity services care provision should be based on the best, most up to date science and evidence.

• Safe doesn’t just mean alive. Safety means something different to everyone.

• Continuity, collaboration, candour and compassion over coercion, control and defensive practice.

One last thought

The promotion and optimisation of physiology (when appropriate) is not ideology or propaganda - it is midwifery. It is deeply hurtful to see the government and media continue to twist and reshape nuanced conversations into simplistic headlines that scare and misinform the public. These false narratives end up having a bigger impact on policy change than any actual evidence ever could, and the cost of that distortion is borne by families and midwives alike.

Midwives stand for, and have always stood for individualised, person-centred, evidence-based care that optimises physiology and ensures safety. I stand ready to continue that legacy - but please, don’t mistake my commitment to physiological birth for an ideological refusal to intervene when necessary. Safety and physiology are not opposing ideas; they can and should co-exist. They are two sides of the same coin, and midwives hold both in balance every single day.

References

Care Quality Commission. (2022). National review of maternity services in England 2022 to 2024 - Care Quality Commission. [online] Available at: https://www.cqc.org.uk/publications/maternity-services-2022-2024?utm_source=chatgpt.com [Accessed 11 Nov. 2025].

www.dictionary.com. (2019). Definition of normal | Dictionary.com. [online] Available at: https://www.dictionary.com/browse/normal [Accessed 11 Nov. 2025].

Hunt, J. (2025). Jeremy Hunt: ‘Normal birth’ ideology is killing babies. [online] Thetimes.com. Available at: https://www.thetimes.com/uk/healthcare/article/jeremy-hunt-nhs-maternity-care-baby-deaths-dlm0vkmvd [Accessed 11 Nov. 2025].

MBRRACE-UK (2023). Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019–2021. University of Oxford.

National Health Service (2020). Antenatal support: meet the team. [online] nhs.uk. Available at: https://www.nhs.uk/pregnancy/your-pregnancy-care/antenatal-support-meet-the-team/ [Accessed 11 Nov. 2025].

National Health Service Digital (2024). NHS Maternity Statistics, England, 2023-24. [online] digital.nhs.uk. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2023-24/ [Accessed 11 Nov. 2025].

National Maternity & Perinatal Audit (2025). State of the Nation Based on births in NHS maternity services in England, Scotland and Wales during 2023. Available at: https://maternityaudit.org.uk/FilesUploaded/Ref%20545%20SON%202023%20data_VF.pdf. [Accessed 11 Nov. 2025].

Nursing and Midwifery Council (2019). Standards of Proficiency for Midwives. [online] NMC. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-of-proficiency-for-midwives.pdf [Accessed 11 Nov. 2025].

Renfrew, M.J. et al (2014). Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet, [online] 384(9948), pp.1129–1145. doi:https://doi.org/10.1016/s0140-6736(14)60789-3.

Sandall, J. et al (2024). Midwife continuity of care models versus other models of care for childbearing women. Cochrane Library, [online] 2024(4). doi:https://doi.org/10.1002/14651858.cd004667.pub6.

Sandeman, G. (2017). Midwives to end campaign to promote ‘normal births’. [online] the Guardian. Available at: https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth [Accessed 11 Nov. 2025].

White Ribbon Alliance (2011). THE UNIVERSAL RIGHTS OF WOMEN & NEWBORNS RESPECTFUL MATERNITY CARE. Available at: https://static1.squarespace.com/static/632cd9a968655d23c4a2ca1a/t/654e81e6ee67f332e236d085/1699643878809/WRA_RMC_Charter_FINAL.pdf [Accessed 11 Nov. 2025].

World Health Organization (2024). Midwifery education and care. [online] World Health Organisation. Available at: https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/midwifery [Accessed 11 Nov. 2025].