Re: Improving maternity services: we must move away from unhelpful labels

Agreement: I AgreeBody:

Dear Editor

We welcome this important contribution to the current discussion on maternity safety. The language we use matters. However, in seeking to learn from failures in maternity care, we must be careful not to create a narrative in which physiological birth itself becomes something from which maternity services need to retreat.

Supporting physiological birth is not the same as pursuing vaginal birth at all costs. Good midwifery care requires the ability to recognise and support normal physiological processes, alongside the clinical judgement to identify when circumstances have changed and escalation or intervention is required. These are not opposing philosophies of care. They are fundamental components of safe maternity care.

Almost a decade ago, responding to an Irish study which suggested that women may have unrealistic expectations of a “practically perfect” birth, we argued that the response should not be to lower women's expectations of childbirth. That argument feels particularly relevant again.

We should be cautious about what becomes accepted as inevitable in maternity care. Rising intervention should not, in itself, lead us to redefine physiological birth as unrealistic, ideological or unsafe. Nor should adverse outcomes associated with failures to recognise deterioration or escalate care appropriately be interpreted as evidence that supporting physiology is the problem.

There is another consequence which deserves consideration. If opportunities to support physiological labour and birth diminish, so too may opportunities for midwives to develop and maintain the skills required to provide this care. Recognising normal physiology is a clinical skill. Importantly, it is also what enables practitioners to recognise when a woman's clinical picture is moving away from normal.

Women deserve maternity services capable of providing timely intervention when it is needed. They also deserve skilled support to labour and give birth physiologically when it is not.

The ambition for maternity services should therefore not be lowered. Safety and physiological birth are not competing aspirations. We should expect our maternity services to be capable of both.

No competing Interests: YesThe following competing Interests: Electronic Publication Date: Wednesday, September 16, 2026 - 17:08AI use: No, I have not used AIHighwire Comment Subject:

Improving maternity services: we must move away from unhelpful labels

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Re: Improving maternity services: we must move away from unhelpful labels

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Improving maternity services: we must move away from unhelpful labels

Check this box if you would like your letter to appear anonymously:: Last Name: O ConnellFirst name and middle initial: Maeve AEmail:

maeve.oconnell@ucc.ie

Address: Brookfield Health Sciences Complex, College Rd, Cork, IrelandOccupation: Lecturer Above the BarAffiliation: School of Nursing and Midwifery, University College Cork, Cork, IrelandBMJ: Additional Article Info: Rapid responseTwitter: @thelovelymaeve