Maternity care in the UK is in a doom loop – how has it come to this? | Zoe Williams

The classic way to outrage someone who’s pregnant is to touch their stomach without asking. I would never do that and it never, back in the day, happened to me – but I always thought, as outrageous as it might hypothetically be, that it also stood as a vivid analogy for the generalised social intrusiveness you get while you’re visibly pregnant. Endless questions about how you’re feeling, when you’re due, what hospital you’re going to, whether it’s a boy or a girl, how much time you have off. I hated this interrogation 20 years ago, but now I do it on a reflex; some driving force of human fellowship makes me want to know. I realised mid-sentence, asking a stranger about hospitals – and replying “That’s a great hospital, my sister had her kids in there” – that it must be even more grating than it was in the 00s. My nieces are 19 and 21 now, and that great hospital, unless it’s magically unconnected to the rest of the NHS, has probably changed quite a lot.

The NHS Alliance has announced that up to 20 of the country’s 155 smaller, consultant-led maternity units, mostly in rural or coastal areas, might have to close, since their safety is in question. The problem – which will seem very pressing and obvious to anyone about to give birth, yet quite abstract and manageable to anyone who isn’t – is that those areas aren’t teeming with alternatives. There are women in Devon whose maternity hospital has been temporarily closed, whose next nearest hospital is 53 miles away. Do they even encourage people to write a birthing plan any more? Because nobody’s, surely, would start: “First, I’d like to spend 90 minutes in a car, yelling at my birthing partner.”

The headline reason is that caesarean sections have risen dramatically, which makes staffing needs more intense. Last year, 45% of births in England were by C-section, 44% as natural vaginal births and 11% by ventouse or forceps, which marked the first time C-sections have been the most common method of delivery. Both elective and emergency C-sections hit their highest levels ever. This is often broadly ascribed to more complex pregnancies – older mothers, more existing health conditions – but one midwifery professor, Soo Downe, said that women “don’t really believe they’re going to have the kind of support they need to have a safe, straightforward, positive labour and birth in hospital”.

Where on earth they could have got that idea is anyone’s guess: maybe word of mouth, or maybe from the scandals that came out of the government’s 2025 national maternity investigation, in which 14 trusts provided rolling horror stories of toxic workplace cultures, avoidable deaths and so-called systemic failures – investigation-speak for “nothing seems to be working”. Emergency C-sections, meanwhile, can also be chalked up to more complex births overall; yet, at the same time, there is no way of knowing how many labours would have proceeded differently had the midwives been less stretched. It’s a doom loop: the more pressure these services are under, the less people trust themselves to fate, the more demand there is for surgical intervention, the greater the pressure.

Twenty years ago, if you’d said you wanted a C-section because you didn’t trust the staffing levels to cope with the unpredictability and longueurs of a natural birth, midwives would have looked at you like you were crackers, perhaps mentally chalking you up as an overanxious mother. Now, many of them would think you were a realist. If you were lucky enough to be pregnant between 2009 and 2011, they then would have handed you £190, to spend on fruit and vegetables (or whatever you liked) – so you’d just walk out of there thinking, “That midwife is incredibly nice”.

Even though childbirth, in its essentials, doesn’t change a lot from one decade to the next, from the perspective of a person in society having to actually do it, it’s changed hugely. Which won’t stop me being curious about the particulars of every fresh miracle – but from now on, I’m working on some tone that isn’t “been there, done that”.