A major review has warned that Wales maternity services staffing levels are insufficient to cope with the rapid rise in caesarean births and labour inductions, raising concerns about patient safety across the country.
The assessment, commissioned by the Welsh government, found that workforce pressures, gaps in national coordination and weaknesses in post-natal and mental health support are placing strain on maternity and neonatal care. While the report recognised the dedication of frontline staff and several service strengths, it concluded that urgent action is needed to address mounting risks.
The Welsh government said it accepted the findings and would strengthen national oversight as part of a three-year improvement programme.
Rising Demand Outpacing Workforce Capacity
The review found that increasing rates of caesarean sections and induction of labour are stretching services beyond current staffing capacity. Shortages were particularly acute in post-natal care and obstetric theatre provision, areas identified as needing immediate attention.
Although the medical workforce — including obstetricians, paediatricians and anaesthetists — has grown by 32.5% since 2015, many of these specialists also support other hospital services, limiting the benefit to maternity units.
Midwife numbers have risen by 13.3% over the same period, but the report noted a significant shift toward a younger and less experienced workforce. Monthly sickness absence among midwives peaked at around 9% in 2021 before easing to 6.3% by July 2025, still considered a pressure point.
Neonatal nurse numbers increased by 24.1% since 2015, though sickness levels remain relatively high at about 8.5%.
Families Report Trauma and Poor Communication
Investigators heard from more than 600 women, parents and staff across Wales. Families who experienced baby loss or serious injury said they were often further distressed by what the report described as “defensive responses” and inconsistent investigation processes.
Common concerns included weak post-natal support, insufficient involvement of fathers and unmet perinatal mental health needs. The review warned that current systems can limit opportunities for learning and improvement.
Zosia Dowmunt from Cardiff described feeling unheard during complications in her first birth, which ended in an emergency caesarean. She said poor communication left her feeling disempowered as a new mother. Her second birth experience, supported by responsive midwives, was “wildly different”.
Staff Morale Under Pressure
The report highlighted growing strain on workforce morale, with staff describing the impact of persistent negative public scrutiny alongside heavy workloads.
Julie Richards of the Royal College of Midwives in Wales said there was strong compassion across the workforce but warned of “serious and urgent challenges”. She called for staffing shortages to be treated as an immediate patient safety issue backed by dedicated funding.
Community advocate Sinnead Ali, who runs a maternal wellbeing hub in Cardiff, said midwives were working extremely long hours and needed better support. She stressed that improving working conditions for staff would directly improve birth experiences for women.
Eight Priority Areas Identified
Rather than adding to more than 500 recommendations already issued over the past decade, the review set out eight priority actions. These include stronger national leadership, urgent focus on triage and induction safety, improved neonatal planning and better mechanisms for learning from family feedback.
The assessment emphasised that fragmented oversight has created what it described as a “vast, uneven landscape” of maternity policy, contributing to what officials termed “improvement fatigue” across the system.
Government Response and Reform Plans
Health Secretary Jeremy Miles said no family in Wales should receive anything less than the highest standard of care and confirmed the government would implement the recommendations.
Plans include establishing a national strategic oversight board, introducing real-time safety monitoring, creating a national best-practice forum and redeveloping perinatal workforce plans to ensure safe staffing levels.
The government also intends to make structured birth discussions routine and develop clearer national guidance for labour induction services.
The findings come as maternity care faces scrutiny across the UK, with a separate major review under way in England. Although stillbirth rates in Wales have fallen between 2014 and 2023, the country still recorded the highest rates in the UK, alongside the highest neonatal death rate in 2023.
Campaign groups say the report confirms long-standing concerns. The Birth Trauma Association welcomed plans for a standardised approach to investigating neonatal incidents, saying families often feel retraumatised by current processes.
Political reaction has also been strong. Plaid Cymru called for urgent implementation of the recommendations, while Conservative and Reform UK figures warned the system remains overstretched and under-resourced.
With demand for maternity care continuing to rise, the report concludes that meaningful improvement will depend on sustained funding, clearer accountability and faster workforce expansion across Wales.