Abstract Purpose of Review This commentary examines how maternity policy in England has shifted after the Ockenden report and asks how services can improve safety without normalising unwarranted caesarean birth. We integrate the Ockenden reviews (2022 and 2026), MBRRACE-UK 2025, the National Maternity and Perinatal Audit (NMPA) State of the Nation report based on births in 2023, and recent evidence on continuity of carer. Recent Findings The NMPA reports that total caesarean birth reached 39.5% in 2023, with planned and unplanned caesarean rates of 16.4% and 23.1%, respectively, while births without instruments fell to 49.4%. MBRRACE-UK reports a maternal mortality rate of 12.82 per 100,000 women giving birth in 2021-23 and persistent inequalities, with higher mortality among Black women, Asian women, and women living in deprived areas. Recent evidence indicates that midwife continuity of care is associated with fewer caesarean births, more spontaneous vaginal births, and better experiences, while a 2026 UK cohort study found lower preterm birth among women in ethnically diverse and disadvantaged communities exposed to community-based continuity models. Summary The 2022 Ockenden report rightly challenged institutional resistance to clinically indicated caesarean birth. However, this resistance occurred against a backdrop of already escalating national caesarean rates, rather than an overall underuse of the procedure. The next phase of maternity improvement should combine Robson-based audit, strengthened counselling for primary caesarean birth and VBAC, renewed access to continuity of carer, timely booking, and equity-focused service planning, alongside updated recommendations from the 2026 Nottingham review. The goal is not a lower caesarean rate at any cost, but the right birth for the right woman at the right time.
Abdalla et al. (Fri,) studied this question.