Where next for Better Births in England? Baroness Julia Cumberlege looks to the future

ISSN 2516-5852 (Online)

AIMS Journal, 2021, Vol 33, No 2

To read or download this Journal in a magazine format on ISSUU, please click here

By the AIMS Campaigns Team

At the end of March, AIMS Volunteers were pleased to attend the NHS England national half-day Better Births Five Years On event. This year the event was inevitably online, but it still managed to retain a very familiar feel. It was hosted by Sarah-Jane Marsh (chair of the Maternity Transformation Board), and an easy-to-use Q&A and polling app allowed for a small amount of audience participation. The event offered a wide range of updates to illustrate the many areas that the Maternity Transformation Programme has focused on since the publication of Better Births in 2016. One striking element of this year’s event was the presentations from each of the regional chief midwives, demonstrating the crucial investment in midwifery leadership being overseen by Jacqueline Dunkley-Bent (England’s Chief Midwifery Officer). Their presentations were each themed around one of the essential and immediate actions set out in Donna Ockenden’s interim report,1 and they illustrated the benefits of a national maternity service in which good practice is effectively shared and lessons quickly learnt.

Disappointingly for the AIMS Campaigns Team, the day was not accompanied by the publication of a definitive report on the progress made so far against each of the Better Births recommendations. We trust that this will be produced soon. But the tone of the day was encouraging nonetheless. Particularly welcome was Julia Cumberlege’s speech, marking the transition from this first five-year part of the programme to its next stage, which showed no sign of relinquishing the recommendations of the Better Births report.

We asked Julia for permission to share her speech, and she has allowed us to reproduce it here. In this speech, she focuses on what we need to take with us on the next stage of the maternity transformation journey, and what we might gladly leave behind. In doing so, she brilliantly captures so many of the key issues that are at the heart of the transformation we need to see, but also the huge team effort that has been undertaken – and that remains necessary – to turn the Better Births vision into a reality. For our part, the AIMS Campaigns Team pledges to be part of that ongoing effort, and we look forward to playing our part over the next five years.

Julia Cumberlege’s address to the Better Births Five Years On conference, 30 March 2021

We have been through a horrendous year of the pandemic but now we have a rare opportunity to think differently, into a new emerging maternity world. What should we take with us? What should we leave behind?

  • Well let’s leave behind bureaucracy, unnecessary bureaucratic systems, structures. Go into our new world, slim, efficient, competent but not weighed down by all that stuff – stuff which intervenes and takes midwives and their colleagues away from women, away from personal and safer care.
  • Let’s leave behind dysfunctional archaic computer systems. And instead take with us new modern technology which enables women not only to access their care records, but to use their mobiles and laptops etc. to converse with their midwife, to build their maternity plan, to chart their journey and give them – the birthing mothers – control over this unique and life changing event.
  • Let’s leave behind the maternity notes, the red book, and embrace Apps and new ways of communicating.
  • Let’s ditch the routines and policies which are not evidence based, which disrupt normal birth, which heighten anxiety for women, their families and staff.
  • Let us leave behind the view that birth is solely a medical event, forgetting the all-important physiology which enriches the mother and baby’s attachment. When things do go unavoidably wrong, let’s act in a timely manner, with skill and consent, whilst feeling empathy and showing compassion.
  • Let’s leave behind labour and birth in stirrups, except where absolutely necessary. It’s degrading for women and diminishes dignity.
  • Let us leave behind dysfunctional teams, hierarchies, and the misery of long shift systems, shifts without a break where work/life balance ends up as a joke.

Let us take with us the precious things:

  • A culture that recognises the hope, joy and potential of birth; pregnancy and birth as transformative, the future of our human race; birth, the start of life – a new life – a new beginning.
  • With care, let’s pack and take with us continuity of carer. Let us enable women and their midwives, obstetricians, nurses, care staff, to really get to know each other, get to trust each other, value the bravery of the mother and share the delight of the family in their new arrival.
  • Let us pack and take with us a love of learning – embrace the challenge. The excitement of renewal. Sharing knowledge among teams, crossing professional boundaries, abandoning those silos. Working with the wider world: analysts, economists, and even lawyers.
  • Let’s take Rapid Resolution and Redress, concentrating on avoidable harm and not the requirement to prove negligence and apportion blame. We can save vast sums of money and enhance safety.
  • Let us rejoice in the enlightenment of a fresh approach working to humanise birth.
  • Let us take with us the good practices – the community services, midwife-led units, stand-alone units, home births – giving women real choice.

And then, who do we take with us?

  • The Maternity Transformation Board and the national team: wizards at getting things done, fighting for more resources, more space, more time. Managing the constant pressure of working in a policy area with so many stakeholders, polarised views, media and political interest.
  • We need to take the Regional teams – the “engine rooms” which embrace all that is in Better Births – and are still working to make our 28 recommendations a reality.
  • The Local Maternity Systems which put maternity ahead of the game, now having to work out how they can be integrated with Care Systems and – in the new world – still be ahead of the game.
  • I want to take with me the Royal Colleges, now under one roof and closer together than they have ever been. The academics and the researchers.
  • I want to take with me all those women and their families, who – 5 years ago – we listened to, and we still do; women who tell us what it is really like, sometimes sad and tragic stories. But they have not given up, they see better ways forward.
  • I want to take with me all those skilled, competent, reliable, thoughtful and inspiring health professionals. People whose eyes light up when they tell me “we are on the cusp, the tipping point; we want to go further, we want the best personalised and safer services in the world; we want to match Sweden, the safest place to give birth in Europe”.
  • I want to take with me the Stakeholder Council who so enrich our thinking, with the charities, National Maternity Voices and the innovators. I want to take with me the brightest and the best in our service.
  • I want to take all of you here today, because you have shown in the last tumultuous year how we can still provide services against all the odds, and who have gone beyond endurance, travelled the extra mile. And I want to thank you from the bottom of my heart.

Above all I want to take with me a copy of Better Births, to monitor and see the fulfilment of the 28 recommendations, because if we achieve that, our maternity services will not be Better Births, but the Very Best Births in the land.

Thank you.


[1] GOV.UK, ‘Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust’: www.gov.uk/government/publications/ockenden-review-of-maternity-services-at-shrewsbury-and-telford-hospital-nhs-trust.


AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: editor@aims.org.uk

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