Are Scotland Maternity Services in Crisis?

Introduction

Maternity services in Scotland have come under increased scrutiny due to persistent concerns regarding patient safety, staff shortages, and systemic failings. Recent investigations highlight a growing crisis, with some maternity units facing allegations of substandard care, inadequate staffing levels, and a culture that compromises both staff well-being and patient outcomes (BBC, 2024). This article critically examines the current state of maternity services in Scotland, exploring the underlying causes of systemic failures while considering contrasting perspectives on the quality and sustainability of maternity care.

Systemic Failings in Maternity Care

Investigations into Scotland’s maternity services have revealed alarming deficiencies. A whistleblower report from the Edinburgh Royal Infirmary’s maternity unit detailed 17 specific safety concerns, with midwives reporting that staffing shortages and a "toxic" work environment endangered both mothers and newborns (BBC, 2024). The report further indicated that some adverse outcomes, including maternal and neonatal harm, were preventable had adequate resources been in place.

The Royal College of Midwives (RCM, 2024) has long advocated for improvements in workforce planning, emphasizing the need for an appropriate skill mix and leadership structures to support safe and effective maternity care. The shortage of midwives in Scotland is particularly acute, with data indicating that many units operate below recommended staffing levels, leading to increased pressure on healthcare professionals and a decline in service quality (RCM, 2024).

A broader systemic issue is the geographical disparity in maternity care access. Women in remote and rural areas often face significant barriers to receiving timely care, sometimes having to travel extensive distances for labour and delivery services. This challenge raises ethical and safety concerns, as delayed access to maternity care increases the risk of adverse outcomes (The Times, 2025).

Contrasting Perspectives: Are Reforms in Motion?

While criticisms of maternity services in Scotland are substantial, some argue that recent reforms and policy initiatives signal a move towards improvement. Healthcare Improvement Scotland (HIS) announced in 2025 that unannounced inspections of maternity units would commence to assess quality of care, patient safety, and staffing effectiveness (HIS, 2025). The Scottish Government has also pledged additional funding to address midwifery shortages and improve training programmes, aiming to attract new entrants to the profession and retain experienced staff (Scottish Government, 2024).

Contrary to narratives of crisis, some studies suggest that maternal and neonatal health outcomes in Scotland remain comparatively strong by international standards. According to Public Health Scotland (PHS, 2024), Scotland’s maternal mortality rate remains low, and perinatal mortality rates have remained relatively stable over the past decade. These statistics indicate that while serious issues persist, they do not necessarily reflect a system in total collapse.

However, critics argue that using broad mortality rates to assess the quality of maternity services overlooks the lived experiences of patients and staff. Reports of near-misses, workplace stress, and patient dissatisfaction indicate that the current maternity system is struggling to provide the level of care expected in a developed healthcare system (Guardian, 2025).

The Need for a Holistic Approach

The crisis in Scottish maternity care cannot be addressed through workforce expansion alone. A holistic approach must consider not only staffing levels but also workplace culture, leadership effectiveness, and regional accessibility. Studies suggest that midwives working in environments with strong managerial support and collaborative team dynamics report lower levels of burnout and improved job satisfaction (Hansson et al., 2022). Thus, improving maternity care quality requires investment in both human and organisational factors.

Additionally, maternity services must be designed to be equitable, ensuring that women in rural and lower-income areas receive the same standard of care as those in urban centres. Policies should focus on sustainable solutions such as telehealth consultations, community midwifery models, and targeted support for at-risk populations.

Conclusion

Maternity services in Scotland are at a crossroads. While efforts to improve care quality are ongoing, persistent systemic failures continue to undermine patient safety and staff well-being. It is crucial that reforms extend beyond reactive measures, incorporating proactive strategies that address workforce challenges, organisational culture, and equitable access to care. The future of maternity services in Scotland depends on a commitment to holistic, evidence-based improvements that place both mothers and healthcare professionals at the heart of policy decisions.

References

BBC (2024) ‘Maternity safety concerns raised at Edinburgh Royal Infirmary’, BBC News, 15 January. Available at: https://www.bbc.com/news/articles/cd60546qxjqo (Accessed: 25 January 2025).

Guardian (2025) ‘Figures reveal 1,500 drug-addicted babies born in Scotland since 2017’, The Guardian, 2 January. Available at: https://www.theguardian.com/politics/2025/jan/02/figures-reveal-1500-drug-addicted-babies-born-in-scotland-since-2017 (Accessed: 25 January 2025).

Healthcare Improvement Scotland (HIS) (2025) ‘Inspections of maternity units to begin in January’, Healthcare Improvement Scotland. Available at: https://www.healthcareimprovementscotland.scot/publications (Accessed: 25 January 2025).

Hansson, M., Dencker, A., Lundgren, I. et al. (2022) ‘Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study’, BMC Health Services Research, 22, 436. Available at: https://doi.org/10.1186/s12913-022-07852-3 (Accessed: 25 January 2025).

Public Health Scotland (PHS) (2024) ‘Maternal and perinatal mortality rates in Scotland’, PHS Reports, 20 November. Available at: https://www.publichealthscotland.scot/publications (Accessed: 25 January 2025).

Royal College of Midwives (RCM) (2024) ‘Looking behind the headlines on Scotland’s maternity services’, RCM Blog, 10 December. Available at: https://www.rcm.org.uk/blog/2024/12 (Accessed: 25 January 2025).

Scottish Government (2024) ‘Action plan to improve maternity care and workforce sustainability’, Scottish Government Policy Brief, 14 October. Available at: https://www.gov.scot/policies/maternity-services (Accessed: 25 January 2025).

The Times (2025) ‘Swinney urged to make "terrifying" 100-mile journey faced by pregnant women’, The Times, 18 January. Available at: https://www.thetimes.co.uk/article/swinney-urged-to-make-terrifying-100-mile-journey-faced-by-pregnant-women-z29g292mv (Accessed: 25 January 2025).