UK Maternity Report Had 'Normal Birth' Criticism Removed Eight Days Before Publication, Says Resigning Investigator Dr. Bill Kirkup

Since the National Maternity and Neonatal Investigation report published on Tuesday and the UK government accepted its key recommendation for a maternity commissioner, a significant dispute has emerged over what the review chose to leave out.

Dr. Bill Kirkup told the BBC that a version of the Amos Review critical of the "normal birth drive" had been signed off by "a significant number of people" on the inquiry team. Then, eight days before publication, that criticism "disappeared."

Kirkup resigned over it. "I don't think it's right that we should push this under the covers," he said. "This is a patient safety danger and I think it should be called out as such."

What the 'Normal Birth Drive' Actually Is

Between 2007 and 2017, the Royal College of Midwives formally encouraged its members to promote vaginal deliveries without medical interventions: no pharmaceutical pain relief, no forceps, no caesarean sections unless unavoidable. The argument was that unmedicated vaginal birth was healthier for mothers and babies.

In practice, the policy sometimes led to women being encouraged to stay home when they needed hospital care, or having caesarean requests denied.

Multiple independent reviews have since found the drive contributed to avoidable deaths and serious harm. Kirkup himself led two of those reviews. Morecambe Bay found midwives pursuing normal birth "at any cost." East Kent reached similar conclusions.

Former Health Secretary Sir Jeremy Hunt wrote last year that "the language, and the thinking behind it, is still alive."

What Kirkup Found in the Amos Review Process

Kirkup said investigators working on the Amos Review had gathered evidence that the normal birth ideology "was still an issue, at least in some places." A draft reflecting that finding was agreed upon by the team. Then the language was pulled.

He declined to describe the mechanics of how the change happened, but said he believes Baroness Amos, who chaired the review, is aware of his concerns. When the BBC asked Amos to respond to Kirkup's claims directly, she refused to comment.

The published report concluded that a "normal" birth agenda was not a contributory factor to poor maternity outcomes, a finding that surprised many campaigners and patient safety advocates who had followed the prior inquiries closely.

The Strongest Defense of the Report

Proponents could argue that the normal birth philosophy has evolved significantly since the Royal College of Midwives formally dropped the campaign, that evidence from prior years may not reflect current practice, and that a broad national review might reasonably reach different conclusions than targeted local inquiries at specific failed trusts. The Amos Review did find serious systemic failures, including that women were "repeatedly not listened to" by maternity services, and its maternity commissioner recommendation has government backing.

Kirkup's counter to that framing is direct. Investigators on the review itself found ongoing evidence the issue persisted "at least in some places," and that evidence was signed off in an earlier draft before being removed.

Why This Matters Beyond the Report Itself

The editorial decision has concrete consequences. If the published report does not flag the normal birth ideology as a live patient safety risk, the maternity commissioner being stood up by the government will work from a brief that excludes it. Midwifery training, trust-level protocols, and the cultural pressure on women during labor will all be shaped in part by what national safety reviews say caused harm.

Kirkup's position is that sunlight is the only fix. "I think it needs daylight shining on it and then we can have a proper conversation about why this sometimes happens and how we make sure that it doesn't keep on happening," he told the BBC.

The specific unresolved question now is who made the call to remove the normal birth criticism from the near-final draft, and under what authority. Baroness Amos has not answered that. Until she does, or until an independent body reviews the drafting process, questions about the integrity of the published report's conclusions on this specific point remain unresolved.