A Commissioner Won't Fix a System That Doesn't Listen
On 20 April 2026, Westminster Hall hosted a debate on e-petition 751174 — a petition calling for the appointment of a dedicated Maternity Commissioner to improve care for mothers and babies. It gathered over 153,000 signatures. It was co-led by Louise Thompson and Theo Clarke. And the debate that followed was one of the most searingly honest conversations about UK maternity care that Parliament has seen in years.
We read it in full. We've been sitting with it. And we want to share our thoughts — because this matters to everyone working in birth, in whatever capacity.
What the debate revealed
MPs across parties shared constituent testimony and their own experiences. The statistics they cited are not new to anyone working in birth support, but they bear repeating:
The maternal death rate in the UK is one of the highest in western Europe, having risen by 21% since the period 2009–2011 — the very period when the government set a target to halve it. Around one in three people describe their birth as traumatic. PTSD affects approximately one in 20 mothers. A Care Quality Commission review of 131 maternity units found 65% were not safe, with only 4% rated outstanding. The NHS now spends more on clinical negligence payouts for maternity care than on the entire frontline maternity service budget.
The recurring theme across every speech — as it has been across every major inquiry of the past decade — was that women are not being listened to. At Morecambe Bay, Shrewsbury and Telford, East Kent, Nottingham: the same pattern, over and over. Women raised concerns. They were dismissed. Harm followed.
MPs also raised the acute racial disparity in these outcomes. Black women remain three times more likely to die during pregnancy or childbirth than white women, and twice as likely to experience stillbirth. Twenty-three per cent of Black women in one survey did not receive the pain relief they requested. These are not statistics. They are the predictable outcome of a system that has not reckoned with its own biases.
The argument for a commissioner, made powerfully by opening speaker Tony Vaughan, is a structural one: there are currently 87 pieces of guidance applicable to maternity care, producing what he described as a postcode lottery. When everyone is responsible, nobody is accountable. A commissioner, the petitioners argue, would be the person with whom the buck stops — tasked with consolidating 750 existing recommendations into a single enforceable national strategy.
But the Government said no. For now.
The Government's position, stated ahead of the debate and unchanged by it, is that there are currently no plans to appoint a Maternity Commissioner. Instead, they are waiting for Baroness Amos to publish her final report and recommendations — expected in spring 2026 — before deciding on the structural response. They have also launched a National Maternity and Neonatal Taskforce, chaired by the Secretary of State himself, to oversee implementation of whatever Amos recommends.
It's worth noting that Westminster Hall debates don't end in votes. The debate was, as these things are, a form of political pressure — not a decision-making mechanism. The real test will be what the Government does with the Amos report when it arrives.
What AIMS has said — and why it matters
AIMS — the Association for Improvements in the Maternity Services — has been doing this work for 65 years. Their response to the commissioner petition is characteristically clear-eyed, and we think it deserves to be widely read.
Their core argument is this: the road to a poorly functioning maternity service is paved with good intentions. The system in England is already "overwhelmed with multiple roles and organisations," each created with the aim of making things better, each now operating in silos, lacking meaningful accountability or leadership. Adding another role — however well-intentioned — without addressing the structural dysfunction underneath risks being, in their words, "an unhelpful distraction."
AIMS are not dismissing the pain behind the petition. They explicitly acknowledge it: "This proposal is a cry for help. We understand that." What they are asking is a harder question: will this actually work? And will energy spent on establishing a commissioner be energy diverted from the deeper systemic reform that is genuinely needed?
Their position is that the case for a commissioner has not yet been made, and that the proposal can only be sensibly considered as part of a wider systemic review — which, conveniently or otherwise, is exactly what the Amos investigation is trying to do.
The OBC view: we agree with AIMS, and here's why
We want to be honest about where we stand.
We understand the impulse behind the commissioner campaign completely. When a system fails you — when you raise concerns and are dismissed, when you are left alone after a traumatic birth, when your baby doesn't come home — the demand for a single accountable person who cannot look away makes total sense. It is a human response to institutional indifference.
But we share AIMS's concern that a commissioner, without the conditions that would enable them to be effective, risks becoming another layer of oversight that doesn't change the experience of the woman on the ward.
What would actually need to change?
Investment. NHS England's own Maternal Care Bundle (more on this below) acknowledges that significant, coordinated resource is required across trusts, ICBs, ambulance services, primary care and community settings. The infrastructure needed to implement even its five initial elements — let alone the 750 recommendations sitting unimplemented across a decade of reports — requires money. Not promises. Not trajectories. Money, now. Midwifery vacancy rates remain catastrophic. Sixty-five percent of inspected maternity units are unsafe. Staff are working 12-hour shifts without breaks. A commissioner cannot fix a staffing crisis.
A change in hierarchy. This is the harder conversation, and the one our previous blog post on antenatal risk classification frameworks touched on directly. UK maternity care is structured around a model that positions the obstetrician above the midwife, the clinical above the relational, and the measurable above the experiential. The evidence has never supported this hierarchy in low-risk care. Midwifery continuity of carer models consistently show better outcomes: fewer caesareans and instrumental births, higher satisfaction, lower costs, equivalent neonatal outcomes. And yet continuity of carer targets were quietly shelved by NHS England in 2022 due to "insufficient staffing." A commissioner operating within the existing hierarchy does not dismantle it. If we want a maternity system that genuinely serves women, we need one that genuinely values midwifery — not as a cost-effective alternative to obstetric care, but as the evidence-based gold standard for the majority of births.
An approach that actually listens to women and birthing people. This was raised in parliament again and again, and it appears in every inquiry. But "listening to women" cannot remain a slogan. It has to mean something about whose knowledge is trusted in the room. It means believing someone when they say their baby isn't moving as much as usual. It means not dismissing a person's request for pain relief. It means treating an individual's embodied knowledge of their own body as clinical data — because it is. It also means engaging with communities who face the greatest disparities: Black and Asian women, women from the most deprived areas, women who are recent migrants, women with disabilities. Engagement with these communities cannot be a consultation tick-box. It has to reshape the system.
What is the Maternal Care Bundle, and does it help?
In January 2026, NHS England published the Maternal Care Bundle — a set of best practice standards across five clinical areas, aimed at reducing maternal mortality and morbidity. It covers: venous thromboembolism in early pregnancy; pre-hospital and acute care; epilepsy in pregnancy; maternal mental health screening; and obstetric haemorrhage management. All NHS trusts providing maternity services are required to fully implement it by March 2027.
On paper, this is exactly the kind of concrete, implementation-focused action the system has been waiting for. It is grounded in MBRRACE-UK data. It acknowledges racial and deprivation disparities explicitly — noting, for example, that Black women die of VTE at more than twice the rate of white women, and of haemorrhage at more than three times the rate. It includes a personalised care framework that states clearly: "service users feel listened to." It requires co-production with Maternity and Neonatal Voices Partnerships at every stage.
These are not small things. We welcome them.
But the MCB is narrow in scope, by design. It focuses on five specific clinical areas that are tractable — where the NHS believes it can make rapid improvements. It is emphatically not a response to the full scope of what Baroness Amos's interim report has found: that the maternity system in England is "not working for women, babies and families, or for staff." It doesn't address continuity of care. It doesn't address staffing ratios. It doesn't address the cultural dynamics that lead to women being dismissed when they raise concerns. It doesn't address the normalisation of harm that the CQC described and that Amos's interim report confirmed.
The MCB is a baseline. It should be a floor, not a ceiling, it doesn't address the need for more well trained, well recompensed, fully supported midwives
What we're waiting for
The Amos final report — expected imminently — is the most significant piece of work in UK maternity policy in years. It has the potential to be genuinely different from what came before, precisely because it has taken a whole-system view rather than focusing on individual trusts. We are watching carefully to see whether its recommendations include a commissioner, a national strategy, enforceable standards, and — critically — a credible mechanism for implementation that doesn't rely on voluntary adoption by trusts who have demonstrated, repeatedly, that voluntary is not sufficient.
Whatever it recommends, the question that will define whether this moment is different from every moment before it is this: will the Government do anything mandatory? Will any of this be binding?
Because we have 750 unimplemented recommendations that tell us what voluntary action produces.
The doula perspective
We want to say something directly to the doulas in our community, and to anyone who works alongside families in the maternity system.
The people signing that petition are the same people we sit alongside in birth rooms. They are the same people who message us months later, trying to make sense of what happened to them. They know the system is broken because they have been failed by it — sometimes catastrophically.
Our role is not to replace clinical care. It is to be a consistent, informed, present support that helps people understand their options, prepare for the complexity of the system they are entering, and feel less alone when that system doesn't show up for them the way it should. That role matters more, not less, in a system under this kind of pressure. And it matters most for the people who face the greatest barriers: those who may not know how to navigate the NHS, those whose concerns are statistically more likely to be dismissed, those who are navigating birth in a second or third language.
What needs to change in UK maternity care is structural, political, and cultural. A commissioner alone cannot achieve it. But neither can any of us alone. The parliamentary debate happened because 153,000 people said: enough. That pressure matters. The Amos report matters. The Maternal Care Bundle matters.
And so does every birth worker who turns up and refuses to let women be invisible in the rooms where decisions about their bodies are made.
The OBC is an evidence-led doula training organisation committed to anti-racist, trauma-informed, full-spectrum birth support. We believe that informed decision-making is the foundation of good birth care — and that the right to make informed decisions must be equally available to everyone.
Read the full Hansard transcript of the debate here. Read the AIMS response here. Read the NHS England Maternal Care Bundle here.