The UK reckons with ‘toxic’ levels of birth trauma, as NSW government moves on recommendations

Two recent inquiries into maternity services in the UK within the last month have found that women and birthing people are at high risk of birth trauma.

Leinweber defines birth trauma as ‘a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long- term negative impacts on a woman's health and wellbeing.’ 

An Independent Review of Maternity Services at Nottingham University Hospitals NHS Trust, called The Ockenden Report after its Chair, senior midwife and childbirth safety expert Donna Ockenden, reported on the NHS’s biggest ever findings of maternity care issues.

The Report identified ‘long-standing and deeply embedded systemic failures across multiple areas of maternity and neonatal care.’

It concluded ‘that most neonatal care at the Trust was good or excellent, but identified a small number of cases where care contributed, or was likely to have contributed, to neonatal death.’

The Report also found a wide range of serious reported failings in care, and ‘psychological distress not only among families, but also among clinicians involved in traumatic births who themselves experienced maternity loss, damage or harm.’

“This Report demonstrates what ensues when leadership, governance and culture are not robust: poor practice is not investigated; learning is not integrated; and mothers and babies are failed by an organisation they should be able to rely upon absolutely during a period of acute vulnerability in their lives,” wrote Ockenden.

Ockenden highlighted that the UK government does not have time to spare in bringing about these changes for families.

The second inquiry, the Independent Investigation into Maternity and Neonatal Services in England, chaired by Baroness Valerie Amos, had over 10,500 women, birthing people and families respond to the public Call for Evidence. 

“Words cannot describe the pain, suffering and trauma I saw and heard time and time again when talking to women and families about their experiences of maternal and neonatal care in England,” wrote Baroness Amos.

The Guardian reported that in the UK, ‘about 31 in every 1,000 birthing women faced serious haemorrhage or tears. The rate of third- and fourth-degree perineal tears has risen to 31.1 in 1,000, from 25 in 1,000 when figures were first published in 2020.’

‘The rate of serious postpartum haemorrhage involving at least 1,500ml of blood loss increased similarly from 25.6 in 1,000 to last year’s 31.65 in 1,000.’

Then UK Health Minister James Murray MP spoke to Sky News in July. 

“There are failings across the board in terms of the whole setup of maternity services, but it is the culture which is wrong,” he said.

Murray said that he thought the culture was misogynistic. 

“I think it’s also a culture of cover-up. Senior leaders, where they’re more interested in covering up failings, rather than putting patients first. I think that one of the first steps in tackling that culture, is accountability.”

The NSW Birth Trauma Inquiry

Dr Hazel Keedle is a Senior Lecturer at The School of Nursing and Midwifery, Western Sydney University. She has worked for over two decades as a clinician in nursing and midwifery, and as a researcher in vaginal birth after caesarean, birth trauma and maternity.

Dr Keedle has produced the Birth Experience Study Australia since 2021, including the study Dehumanized, Violated, and Powerless,’ a nationwide cross-sectional survey.

“We got nearly 9,000 responses across every state and territory in Australia. One of the questions was about obstetric violence and one about birth trauma. And we'd never asked that question in Australia before.”

Obstetric violence is defined as dehumanised treatment or abuse by health professionals towards the body or reproductive process of women — it’s not limited to obstetricians and can be any health provider involved in the health of women according to Dr Keedle.

“The result was 11% [had experienced birth trauma]. Honestly, reading some of those experiences was jarring. I felt as a researcher we had to give a voice to those women.”

After Dr Keedle shared her information with consumer organisations, some began to email politicians. Emma Hurst MP was interested and ultimately chaired the NSW Birth Trauma Committee.

Dr Keedle said that the NSW Birth Trauma Inquiry (NSWBTI) was brought about by women, researchers, and organisations, including groups of women from Wagga Wagga, and Illawarra.

“We got over 4,500 responses or submissions, which is the largest they've ever seen. It found that 28% of women described birth trauma, which is about a third of women.”

The NSW Birth Trauma Inquiry response

The NSW government either supported, or supported in principle, each of the recommendations (and noted one action) from the NSWBTI report.

“And one year later in the NSW budget, there was a lot of money put towards some of these changes,” Dr Keedle said.

In 2025, the NSW government allocated $83 million to maternity care in the state budget. 

The ABC reported that $44.8 million will go towards expanding the state's midwife-led program, Midwifery Group Practice (MGP), [and] an additional 53 midwife roles in regional and remote NSW, with improved training for clinicians in respectful maternity care and enhanced antenatal education for patients in the wider package.

“It's far away from saying that every woman in New South Wales has the option of continuity of care with the midwife, but it's a move forward,” Dr Keedle said.

Controversy over the term 'obstetric violence'

In June 2026, in response to the NSWBTI, Dr Keedle published “We shouldn't have to beg to be heard,” a qualitative framework analysis of the public to the NSW Inquiry.

“The category with the highest number of inclusions from submissions was obstetric violence, followed by lack of care and support, physical trauma, loss of control, and fear for own or baby’s life.”

The study found ‘recurring themes of obstetric violence, lack of care and support, physical trauma, loss of control, and fear for maternal or neonatal life. Obstetric violence emerged as the most frequently mentioned experience, yet this critical issue was absent from the inquiry’s final report and government response.’

“Some of those common themes are feeling of a loss of control and a loss of autonomy. It could be the use of coercion. It could be losing their baby, or it could be the fear of the fact that their baby was going to die. It could be a fear for their own life.”

She said that a big factor in the paper was using the term ‘obstetric violence.’ 

The paper found that 70% of those submissions mentioned a form of obstetric violence.

“It is a very emotive term for people, for clinicians and for women. I will always have to be in favour of using it because the terminology came from women.”

Despite the dissenting opinion of Emma Hurst, the term ‘obstetric violence’ was left out of the NSW Birth Trauma Inquiry report.

“It’s not liked because, clinicians and doctors — obstetricians — it makes them feel like they are causing harm deliberately,” Dr Keedle said. 

“It kind of makes you go, ‘Am I this perpetrator?’ But it's actually okay to sit in that discomfort. It's okay to reflect on your own practice and go, ‘Alright, well, maybe just because I'm not doing this doesn't mean somebody else isn't.’”

“We have a violence against women issue in Australia with more than one woman a week dying because of violence against women.”

“One of our challenges is, how can we get everyone to the party? How can we get everyone to the table and talk about this?”

"Importantly, when you look at the submissions made to the NSW Birth Trauma Inquiry, many women were describing experiences that occurred years or even decades ago. This tells us birth trauma is not a new problem that has suddenly emerged; rather, it is an issue that has existed for a long time and is now receiving the attention it deserves."

Overall, there have been some positive outcomes when it comes to birth trauma.

"What has changed is the level of public awareness and discussion,” Dr Keedle said.