Why It Helps to Understand the History of UK Birth Policy
From Albany to Ockenden
— How a Vision for Continuity Became a System of Crisis
Prior to the home birth suspension I learned that Gloucestershire has decommissioned its three continuity teams, reportedly citing the Ockenden Review and staffing pressures.
It’s true that there are not enough midwives on the ground
— a national crisis that impacts safety —
but what’s rarely discussed is why so many are leaving:
bullying, burnout, loss of respect, and the erosion of autonomy.
To understand how we reached this point, and advocate effectively for real change it helps to look back.
What began as a movement for relationship-based, woman-centred care
has gradually been replaced by bureaucracy and fear.
🕊️ The Albany Model (1990s – 2009)
The Albany Midwifery Practice in South London pioneered genuine continuity within the NHS.
Small midwife-led teams cared for women they knew throughout pregnancy, birth, and postnatally.
Outcomes were exceptional
— lower intervention rates, fewer premature births, higher satisfaction.
When the Albany was closed by King’s College Hospital in 2009, despite strong evidence and public support, it foreshadowed the system’s growing discomfort with autonomy and relational models of care.
Closure is a harrowing, factual, blow by blow account of the dismantling of a successful female led, autonomous, safe practice by faceless fearful white coats.
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2016 – Better Births: A National Vision Reborn
The Better Births Report reignited the Albany vision
— maternity care that was personalised, kind, safe, and family-friendly,
with most women receiving continuity of carer.
It introduced Local Maternity Systems (LMS)
to encourage collaborative planning between Trusts, commissioners, and service users.
For a brief moment, it felt possible: a return to midwifery-led continuity supported by national policy.
⚖️ 2017 – The End of Supervisors of Midwives
Following the Kirkup Report into Morecambe Bay, the independent Supervisors of Midwives (SoMs) were abolished in 2017.
Their statutory function was replaced by the Professional Midwifery Advocate (PMA) role, introduced under the AEQUIP framework (Advocating for Education and Quality Improvement).
Unlike the former SoMs, PMAs are employed within NHS management structures, not independently appointed.
The intention was to streamline regulation, but in practice this removed an autonomous layer of professional advocacy and peer oversight, leaving many midwives feeling less supported and less able to raise concerns safely.
😷 2019 – 2020 – Better Births Four Years On & the COVID Crisis
By 2020, Better Births Four Years On showed patchy progress.
Then the COVID-19 pandemic struck:
🏠 Home births suspended in many areas.
🚫 Partners restricted during labour and postnatal stays.
🔁 Continuity teams redeployed to cover gaps.
Thousands of women gave birth without a known caregiver
— a devastating reversal of everything Better Births promised.
📉 2020 – 2022 – The Ockenden Review Fallout
The Ockenden Review into Shrewsbury & Telford revealed catastrophic safety failings.
Rather than invest in staffing and relationships, many Trusts responded with centralisation, extra oversight, and “pausing” continuity teams — despite clear evidence that continuity improves outcomes.
The issue was never the model; it was under-resourcing and systemic fear.
✊ 2021 – 2023 – Equity, Partnership & New Policies
📗 Equity and Equality Guidance (2021): Tackled disparities and embedded co-production.
Working in Partnership with People and Communities – Statutory Guidance (2022):
That NHS England document — Working in Partnership with People and Communities: Statutory Guidance — is essentially the rulebook that turns “listening to the public” from a nice idea into a legal duty. It lays out how Integrated Care Boards and NHS Trusts are required to involve, collaborate, and co-produce with the people their services affect. In maternity care, that means not just inviting feedback after decisions are made, but sharing power and responsibility from the start — shaping services alongside women, families, and communities. It’s the foundation that makes genuine co-production a statutory obligation, not a box-ticking exercise.
Three-Year Delivery Plan for Maternity and Neonatal Services (2023–26):
That national Three-Year Delivery Plan for Maternity and Neonatal Services sets the standards every local system is expected to meet.
It pulls together the lessons from Ockenden, Better Births, Kirkup, and the wider maternity safety investigations and turns them into a clear, non-negotiable roadmap: safer staffing, respectful cultures, relational care, proper community engagement, and a shift towards genuine co-production with families.
It’s the benchmark against which local systems — including Gloucestershire — are measured.
If a Trust claims to be “in transformation,” this is the document that defines what that transformation must actually look like.
Getting the Workforce Right (RCM)
Getting the workforce right isn’t an abstract policy point
– it’s the heart of everything. Every major inquiry into maternity care has said the same thing in different words: when midwives are stretched, undermined, or pulled away from “with-woman” practice, women and babies feel the impact.
Safety isn’t just about protocols; it’s about having skilled, confident, supported midwives who can actually do their job.
It means proper staffing, decent conditions, real autonomy, and a culture that values midwifery as a profession rather than treating midwives as shift-fillers. When midwives are respected and resourced, women get safer, calmer, more human care.
That’s the workforce vision the RCM keeps pushing for, and it’s the one families deserve.
2024 – The Prestwich Home-Birth Tragedy
The Prestwich Home Birth Tragedy exposed what happens when autonomy and continuity vanish.
A midwife dispatched after a 12-hour shift, unfamiliar with the woman or her plan.
Essential equipment failed at the worst moment.
When midwives are exhausted, unsupported, and denied decision-making power,
such tragedies are not rare events — they’re the inevitable outcome of a system set up to fail.
🤝 2025 – Working in Partnership with People and Communities Policy
The latest NHS England policy (2025) now requires systems to
demonstrate real partnership and co-production
— including with voluntary and independent providers.
This opens the door for Independent Midwives and community partnerships
to help rebuild the continuity model that Better Births once envisioned.
There are actually two separate NHS England documents covering partnership and co-production, and they serve different purposes.
The first – the 2022 Statutory Guidance – sets out the legal duties for ICBs and NHS Trusts.
It tells local systems what they must do: involve communities, work in partnership, and build services with the people who use them.
The second – the 2025 Policy – is NHS England applying those same principles to itself. It explains how NHS England, as a national body, will work in partnership, share power, and embed co-production in its own internal work. One defines the obligations for local systems like Gloucestershire; the other describes how the national leadership intends to model those standards.
🌼 What This Means Now
From the closure of the Albany to the disbanding of continuity teams, the pattern is clear:
each reform born from tragedy, each improvement undone by fear.
Continuity teams were never the danger — it was the remedy.
If maternity services like Gloucestershire truly want safety,
they must rebuild what has been lost:
trust, respect, and autonomy for both women and midwives.
If I’ve missed something, let me know below…
About the Author
Emma Gleave is an antenatal educator, doula (birth companion), and advocate for maternity reform in the Forest of Dean. Through Emma’s Antenatal and Wildlings Ed CIC, she combines evidence-based education with community action to promote continuity, autonomy, and respect in birth care.