Having personally birthed in all four birth settings, I have experienced first-hand how choice around place of birth has narrowed. To explore this further, I collated the views of almost 1,500 women and birthing people from across the North East of England and Yorkshire. Their message was clear: choice matters, safety is related to personal perspective, and most would prefer a midwife-led option if they were genuinely available to them. True informed choice is fundamental to both safety and experience, and without all four birthplaces being open and offered, women and birthing people are being denied their rights.
Midwifery Units (MUs) are supported by substantial evidence demonstrating better outcomes, high service-user satisfaction and cost-effectiveness. Despite the benefits, their provision and utilisation remain limited and vary greatly across health systems. Emerging research addresses the organisational, professional and social factors shaping the implementation and sustainability of MUs. This article presents MU definitions, key characteristics and their significance in the current state of maternity care systems.
Midwife-led birth centres provide safe, evidence-based, respectful maternity care, promoting physiological birth and continuity of care. In humanitarian settings, they are vital. Afghanistan faces high maternal health needs amid conflict, poverty and gender restrictions, where midwives are essential. This article describes how the Afghan Midwives Association (AMA), with partners, established Midwife Led Care Centres, outlining policy, implementation, organisational structures and lessons, demonstrating how midwife-led models advance quality, women-centred care in fragile, resource-limited context.
Midwifery units (MUs) offer a bio-psycho-social model of care that supports safe physiological birth and good outcomes, yet racialised women are less likely to access these settings. Structural racism, risk-averse practices and cultural assumptions about safety contribute to unequal uptake. Disproportionate exclusion through risk assessment, limited information provision and biases about who MUs are for further restrict access. Evidence suggests MUs can be safe and beneficial for women with intermediate risk factors who are often excluded. We discuss strategies to improve equitable access.
The newborn skin microbiome is basically a tiny ecosystem of bacteria, fungi and viruses that starts forming right from birth. Most of these microbes come from the mother and the baby’s immediate surroundings. Over the first two to three years of life, this community gradually grows and becomes more stable.1
Midwife-led units (MUs) are associated with benefits for women, birthing people and their babies and are important for increasing personalised and respectful maternity care. In the United Kingdom (UK), maternity care improvement and increasing care provision in community settings are a high priority. In this paper, we introduce the Midwifery Unit Self-Assessment (MUSA) Framework, which supports the quality improvement of MUs. We outline the development of MUSA and its national implementation in Wales, highlighting how it can address challenges faced by MUs and by quality improvement initiatives to embed and sustain positive change.
Ten years on, the Midwifery Unit Network (MUNet) has delivered diverse training across the UK and internationally to enhance maternity care by strengthening the core skills of midwives working in Midwifery Units. Fragmented maternity services and the dominant medical model negatively affect midwifery education, limiting consistent student exposure to Midwifery Units and physiological birth, and raising concerns about preparedness for practice. MUNet’s bespoke, evidence-based learning strengthens midwives’ confidence, autonomy and skills while supporting sustainable improvements in maternity services.
The Midwifery Unit Network has supported the implementation and continuous improvement of midwifery units within a complex and evolving European context. Through sustained networking activities, we have disseminated evidence on midwifery units and influenced practice and policymaking. Our Academy has contributed to the ongoing development of hundreds of maternity care professionals and students. The Midwifery Unit Standards have been widely adopted across Europe and beyond. In this article we celebrate key achievements, reflect on persistent challenges and renew our commitment to maternity care that is evidence-based, equitable, respectful and firmly grounded in the human rights of women and birthing people.
Midwifery is so much more than ‘delivering babies’ – it is about leadership, advocacy and influencing healthcare systems. In this account, I share my journey from clinical midwifery to national leadership, shaped by my experiences as a Florence Nightingale Foundation (FNF) Scholar. Through mentorship, peer support and personal growth, I have discovered the power of midwifery leadership in shaping policy, driving change and inspiring future generations. This journey has reaffirmed the importance of mentorship, collaboration and embracing new challenges, and has made me consider: where will my career take me next?
Undertaking a PhD is a challenging and often isolating experience that requires intellectual rigour and emotional resilience. This paper explores the role of female friendships in academia as a joint coping and self-care strategy for early career researchers (ECRs). Drawing on existing literature and reflective experience, this paper presents a model exploring how female friendship can contribute to a sense of belonging, well-being and professional development, as well as counteract the patriarchal, neoliberal, White Western structures.
To clarify the meaning of neonatal near misses (NNM), a concept analysis using Walker and Avant’s method was conducted. The analysis identified severe neonatal complications, life-threatening conditions, timely and effective intervention and the survival and recovery of the neonate as defining attributes of NNM. This study builds on the first article in this two-part series Maternal Near Misses: A Concept Analysis. This second article extends the concept to neonates, providing a comprehensive understanding of NNM and highlighting the critical factors for improving neonatal outcomes.
Students are the future of midwifery practice and vital to the sustainability of the workforce.1 Four years post qualification, I wondered if it was too soon in my career to apply for a midwifery lecturer role but nearly one year on, I am so glad I did. Having undertaken practice education roles in the NHS, I felt it was critical to provide excellent midwifery education to students. Working in academia, I can support more students over a longer period and hopefully have a positive impact on the next generation of midwives. Prior to applying for this role, I struggled to find others who had followed a similar career pathway, and I wanted to share my experiences, to inspire others.
At some point in every person’s life, they are likely to face adversity. Experiences or events can be experienced as traumatic – a perceived threat of injury, death or to physical safety.1 Trauma-informed care (TIC) is a framework for recognising the negative impacts of trauma; establishing good quality care to ensure an accessible and welcoming service.2 Sometimes a history of trauma is not disclosed or even recognised, therefore all maternity service users can benefit from a universally compassionate approach.3,4 Embedding these approaches may require cultural and organisational change, and this article will explore the Professional Midwife Advocates (PMA) role in achieving this.
Midwives are a guardian of the birth space, ensuring women feel safe, empowered and in control of their birth experience. A psychophysiological care pathway can ensure women’s emotional and cognitive needs are being met, as well as their physical needs ensuring holistic safety. By building a ‘birth nest’ women can feel secure and protected within the birth space without the feeling of being hyper-observed. Through connection, midwives can offer compassion and emotional reassurance to the woman which is based on a relationship of trust. Through the development of essential midwifery skills, midwives can consider how to strengthen the psychophysiological care they provide women during labour and birth.
Midwives are skilled, independent professionals with a long-standing history of improving maternal and neonatal outcomes. Despite their critical role, midwifery often faces systemic barriers, including undervaluation and exclusion from decision-making processes. To overcome these challenges, midwives must lead research that reflects their priorities, ensuring care remains evidence-based and woman-centred. This research creates a ripple effect, shaping education, policy and practice while reinforcing midwifery’s autonomy and professional identity. Pursuing advanced education equips midwives to analyse, critique and apply evidence effectively, not just participating in the dialogue but creating the conversation that drives the future of maternal and neonatal care.
This article explores the ground-breaking cultural and policy transformation in maternity care marked by the shift from ‘shared decision making’ to ‘informed decision making’, as outlined in the NHS England Personalised Care and Support Planning Guidance for Local Maternity Systems (2021).1 This change – driven by sustained advocacy and grounded in human rights law – recognises the woman as the ultimate decision maker in her care. Rooted in the principles of autonomy, continuity and cultural safety, this approach challenges top-down safety models dominated by institutional control and establishes informed decision making as the cornerstone of true safety and respect in maternity care.
Sexual violence is a pervasive public health and safeguarding concern with significant implications for individuals, families and communities. The impact of violence can shape pregnancy, birth and parenthood experiences; therefore, it is critical that midwives are able to recognise, understand and respond to sexual violence in practice. This five-part series explores sexual violence in the perinatal context, highlighting prevalence, sociocultural influences, legislative frameworks, service provision and trauma-informed care. This first article defines sexual violence, examines its prevalence and impact and considers maternal, foetal and neonatal consequences. Together, the series of articles offers insights that enable midwives to navigate complex professional responsibilities with sensitivity and confidence, promoting safety and fostering compassionate, person-centred, equitable maternity care.
In this issue’s Voices article we hear from Dr Helen Jinguo Zhai, Head of Midwifery at Southern Medical University and China’s first PhD in midwifery. Helen shares her impressive work to strengthen midwifery practice, research and leadership throughout her career prompted following her research activity with the University of Dundee, Scotland. Helen has also been brought to life as our Midwife of the Moment on the front cover of September 2025 issue, take a look at her meaningful moments alongside reading her article.
Following a recent visit to Norway I reflect on the lessons that United Kingdom (UK) maternity services could learn from Norway’s healthcare system. This reflective paper examines the application of three leadership theories: transformational leadership, distributed leadership and servant leadership within Norway’s healthcare system, particularly focusing on maternity services. As a facilitator of leadership development programmes, I do not advocate for one style of leadership above another but rather a dynamic and flexible approach where benefits can be gained from adapting styles to the situation and the benefits to be realised. UK maternity services can learn valuable lessons from Norway’s healthcare leadership practices.
