To: Dame Ruth May, Professor Jacqueline Dunkley Bent, Dr Matthew Jolly, Professor Jane Sandall, Dr Bill Kirkup, Baroness Julia Cumberlege, Sir Cyril Chantler, Gill Walton, Dr Renee Thakar, Stephen Barclay, Wes Streeting, Anneliese Dodds, Professor StJohn Crean

We are writing to you with concerns regarding the recent news reports published in the ‘i’ Newspaper.

One of the reports confirmed that no one from NHS England will attend the long-running Normal Labour and Birth International Research Conference, to be held in April 2023 in Cumbria, UK. It is our understanding that this decision was made in response to a letter written by a group of families who encountered loss and harm while using NHS maternity services.

We deeply empathise with the families who have written to Dame Ruth May, who have experienced the unspeakable loss of a child. We recognise that they have endured life-changing and devastating experiences in the NHS, motivating them to advocate for change in the UK maternity services. We too are genuinely concerned about the safety of mothers, birthing people and their babies. We also long to see the much needed changes necessary to improve maternity services, and we are gravely concerned that NHS England is prohibiting learning opportunities that would impact all families. This decision was made without consulting those deemed most at risk and systemically experiencing the worst maternal and neonatal outcomes.

It was also alarming to read in the ‘i’ Newspaper that keynote speaker, Dr Bill Kirkup has been persuaded not to attend the event to talk about the key findings from the East Kent report. The irony of his decision to withdraw is deeply disappointing. If individuals believe the dangers of physiological birth are contributing factors as detailed in the report, then this conference and others like it are the exact places these findings should be presented and discussed.

We firmly believe that decisions made on behalf of NHS England should be informed by a diversity of opinions and lived experiences of service users. In our view, prohibiting NHS England staff from attending a scientific conference on physiological birth, and preventing key findings from being shared, is a loss of a learning opportunity to strengthen maternity care policy, practices and clinical care to improve outcomes. We question whether the letter that influenced Dame Ruth May’s and Dr Kirkup’s decisions sufficiently represents families who are, but not limited to:

● People from Black, Asian and minority ethnic groups

● Families with varying socioeconomic backgrounds

● Women, birthing people and families who are choosing to optimise physiology, including when an adverse outcome or loss is foreseen (such as miscarriage or stillbirth)

● Women, birthing people and families who want to optimise physiology to ensure the best possible start to infant feeding, family life and long-term physical and mental health.

● Fathers, parents and birth partners experiencing and witnessing trauma caused by a lack of knowledge and the skills needed to optimise and support physiological labour and birth.

Through the knowledge, sharing and debate of scientific research at conferences, there are opportunities for public health practitioners, clinicians and researchers to come away with a better understanding of how to optimise physiology and support personalised plans for spontaneous labour and births.

We would also like to remind you that women, birthing people and families from Black, Asian and minority ethnic backgrounds are disproportionately faced with infant loss, and we have yet to see the views of such groups explicitly represented. NHS England does not appear to have considered the implication of disrupting attendance to research conferences and thus suppressing information sharing. This decision could further increase inequalities and perpetuate marginalised service users' adverse outcomes and experiences.

It seems a minority of families have named the ‘dangerous ideology’ of normal birth as a detriment to safety in maternity care. We do not believe that physiological birth is a primary cause of most deaths. This claim is out of step with both national and international guidelines and policies, which emphasise the optimisation of physiological birth and upscaling of midwifery-led care. All evidence shows that this improves maternal and infant health outcomes and experiences. As service users, birth supporters and maternity improvement campaigners, we believe strongly in autonomous midwifery practices informed by a grounding in physiological birth.

All recent maternity reports say that women should be listened to, but this is all women, birthing people and their families. Safe care is defined differently depending on the individual, and is shaped by the circumstance, culture, faith, spirituality, lived experience and family life of those accessing maternity care. It is paramount to start listening to a range of individuals accessing maternity services and to ensure maternity staff can benefit from all opportunities to develop the skills needed to support genuine choice and personalisation as part of safe maternity care.

Knowledge and experiences of physiological birth are already very limited. Restricting learning opportunities about physiological labour and birth will only make maternity care less safe, not safer. We are already seeing the devastating impact of this and are facing the worst crisis maternity services in the UK have ever seen. For example:

● Women and birthing people are choosing to freebirth rather than birthing with NHS midwives due to the fear displayed in supporting physiological birth and/or not having the skills or experience needed to support personalised care plans that aim to optimise physiology during labour and birth.

● Midwives are qualifying having attended 40 births but may never have seen or supported physiological birth.

● Midwives are giving up their registration in fear of being persecuted for supporting women and birthing people when they choose to have physiological labour and birth, feeling that it’s the only way to protect themselves.

● Doulas are choosing not to support women and birthing people when they opt into NHS care, due to the lack of skills and knowledge of physiological birth of those providing maternity care. Doulas are witnessing unnecessary harm, abuse, coercion and suffering which is detrimental to the families and their well-being.

We urge NHS England and decision-makers to:

● Ensure NHS maternity staff have the knowledge, skills and experience to support physiological labour and birth, and to recognise when intervention might be appropriate.

● Implement the Better Births priorities regarding continuity of carer, personalised care and choice to ensure safety and maternal satisfaction.

● Make certain the voices and experiences of Black and Brown women and families are actively sought and considered when making key decisions impacting maternity services and their transformation.

● Redesign maternity care to include the ethos of cultural safety, taking into consideration power imbalances, the paternalisation of women’s decision-making, and the marginalisation of the midwifery profession.

Most women and birthing people want and can have physiological labour and birth. We need midwives and doctors with the necessary skills, experience and knowledge to support physiological labour and birth, and experts in optimising this as directed by the Nursing and Midwifery Council. Only then can they recognise and provide information when interventions are required. This is what saves lives, the relevant knowledge and skill. Given that such learning opportunities are already limited, we once again urge you to reconsider any attempts to prohibit attendance and eradicate opportunities to share learning and research at events such as the Normal Labour and Birth International Research Conference.

Yours Sincerely,

*This letter is signed in an individual capacity. The views and opinions expressed do not necessarily reflect that of any organisation they are associated with or employed by.

Sallyann Beresford - Mother of 4 children, doula, antenatal educator and author.

Lina Duncan - Former International midwife trained in physiological birth and worked in stand alone midwifery clinics where clients had information, access and aid to transfer to a hospital when medical intervention was needed/wanted. Currently a Birth and Postnatal Doula.

Erin Fung - Lived experience of 4 pregnancies, mother of 3, hypnobirthing and birth educator, guest lecturer, service user representative and chair for a Maternity Voices Partnership in South East London

Samantha Gadsden - Doula, Activist, founder of, They Said To Me, an awareness-raising platform for pregnant and birthing women and people to share experiences of obstetric violence, The Home Birth Support Group UK with over 12,000 members, a freebirth community of over 1,000 members and The Village, an ongoing parenting support group with nearly 6,000 members.

Kicki Hansard - Author and Doula Course Facilitator.

Anna Horn - Mother of 2, Doula, Black Maternal Health Advocate, PhD Candidate at City, University of London and former Service User Representative for the Maternity Transformation Programme (Oct 2019 – Oct 2020)

Caleb Horn - Father of 2, a husband who supported his wife to optimise physiology during a high-risk pregnancy and birth.

Kemi Johnson - Former registered midwife now birthkeeper.

Mars Lord - Mother of 5 incl twins. Life and mindset coach. Doula educator, founder of Abuela Doulas the first Black owned and founded doula education/training course

Maddie McMahon - mother of two physiologically born children, doula trainer, breastfeeding counsellor and author.

David Monteith, Father of 3 living and 1 dead child. Founder of Grace in Action. International Stillbirth activist and speaker. Speaking engagements include The Lancet Stillbirth Series Launch, Women Deliver Conference (Denmark) March for Moms (Washington) Countless midwifery conferences and training events around the British Isles

Louise Oliver - Lived experience of 6 pregnancies, Mother of 4 children - the 4th being an informed and planned freebirth, pregnancy & birth trauma survivor, CIC Director, Equity, Diversity & Inclusion Lead, Breastfeeding Counsellor, Speaker and Doula.

Michelle Quashie - Lived experience of 7 pregnancies, Mother of 4 children, Maternity improvement campaigner, Founder of the Women's Voices conference, and former Service User Representative for the Maternity Transformation Programme.

Jay Quashie - Father of 4, a husband who supported his wife through the medicalised and physiological experience of both loss and birth.

Leonie Rainbird-Savin - Mother of 3, freebirthed all with varying levels of NHS engagement. Birthkeeper supporting families navigating services & moving away from mainstream care, towards unassisted pregnancy, birth and postpartum.

Becky Reed - Albany Practice midwife (retired), specialising in relational continuity. Doula, author, mother of 4 and grandmother of 12.

Carmen Rocha - Mother of 3, birth mindset coach, VBAC mentor and doula.

Natasha Smith - Lived experience of 5 pregnancies, Mother of 3 children, Birth Trauma and HG survivor, Women’s Health Advocate, Educator and Parenting Specialist, and Former Service User Representation for the Maternity Transformation Programme.

Mik Smith - Father of 3, Vicarious birth trauma, protector and loving supporter of his wife through hyperemesis gravidarum and loss.

Steph Wild - Registered Midwife, Founder of Beyond Bea Charity, Mother to Bea (who died in 2017), Bereavement Consultant.