Expert witnesses from McCollum Consultants reflect on the latest national findings, including MBRRACE-UK’s September 2026 report on maternal deaths, its June 2026 perinatal mortality report and the final report of Baroness Amos’s National Maternity and Neonatal Investigation, and consider what they mean for clinical practice, for families and for those advising them.

What the latest findings tell us

Fewer babies are dying than a decade ago, but progress is not shared equally. The latest MBRRACE-UK perinatal mortality report, published in June 2026, found that the UK extended perinatal mortality rate fell to 4.77 deaths per 1,000 births in 2024, 21% lower than in 2013.

However, babies born to mothers living in the most deprived areas continue to experience the highest rates of stillbirth and neonatal death, and Black and Asian babies continue to experience higher mortality rates than White babies. Babies born preterm remain at greatest risk. There are encouraging signs too: neonatal mortality for the most deprived group fell by 14%, and the gap between the most and least deprived areas narrowed slightly.

The most recent MBRRACE-UK State of the Nation report, published in September 2026, reported that between 2022 and 2024, 252 women died during or up to six weeks after pregnancy, a rate of 12.80 per 100,000 maternities and 20% higher than in 2009-11. Black women were nearly three times more likely to die than white women. Where care could be reviewed in depth, assessors found that improvements to care may have made a difference to the outcome for 61% of the women who died.

Several findings bear directly on babies as well as mothers. In one case, a woman at very high risk of uterine rupture had her planned caesarean postponed twice because of theatre capacity; she and her baby both died, and assessors believed both would have survived had the operation gone ahead as planned. With caesarean births rising from 33% of all births in 2020 to 45% in 2025, the report warns that capacity is becoming a patient safety issue, and assessors suggest that delaying a risk-reduction caesarean for a high-risk woman should be treated as a clinical incident. Five women died from sepsis following preterm prelabour rupture of membranes, all with an associated intrauterine fetal death, and only two had documented counselling about the risks of continuing the pregnancy.

The report also reiterates that concerns raised by women must be listened to and escalated and warns that incompatible electronic patient record systems can lead to gaps in communication and missed deterioration. Of particular note for those reviewing cases, it calls for the readability of records produced for review processes to be improved.

In June 2026, Baroness Amos also published the final report of the Independent National Maternity and Neonatal Investigation. Its eight recommendations include treating listening to women and families as a critical safety issue, improving investigations and learning when things go wrong, and creating a statutory Maternity and Neonatal Commissioner. A national action plan is expected in December 2026.

Several recommendations are of particular relevance to practitioners. The report calls for a right to independent review when things go wrong, improvements in the quality, transparency and accountability of investigation reports, and a review of the compensation system for adverse maternity events. Together with the Health Bill, through which the Commissioner is expected to be established, these changes are likely to shape how maternity incidents are investigated and how claims are assessed in the years ahead.

Some of our experts consider the recurring issues they encounter in clinical practice and medicolegal review, and what the findings may mean for the standard of care, causation and the investigation of adverse outcomes.

Mr Anastasios Malakasis, Consultant in Obstetrics & Maternal Medicine

Baby Loss Awareness Week offers an opportunity to reflect on the impact of loss on parents and families. The same time it reminds us, as clinicians, the continuous commitment to excellent care for pregnant women.

The latest MBRRACE-UK findings are on one hand positive considering the fall in the numbers of stillbirths and neonatal deaths but on the other hand they are alarming in terms of maternal mortality. In addition, it highlights the inequalities especially in vulnerable women. The Baroness Amos’s Independent National Maternity and Neonatal Investigation reinforce the importance of listening to families and put our efforts to be open and learn from poor outcomes.

Obstetricians and their multidisciplinary colleagues are deeply committed in providing care in complex and high-risk situations but despite the highest standards of care, not every adverse outcome can be prevented.

It is paramount as medicolegal experts that every adverse outcome is being approached with professionalism, expertise and objectivity but also with the appropriate sensitivity.

Miss Chandrima Biswas, Consultant Obstetrician

The recently reported fall in stillbirth and neonatal death rates offers some reassurance that the many mandated national quality improvement initiatives may be starting to have an effect. However, there remains considerable room for improvement, particularly given the persistent inequalities affecting women from global majority groups and those from deprived backgrounds. The Amos Report confirms that women do not feel their concerns are listened to, and this problem may be more pronounced among women experiencing health inequalities. Clinical guidelines are designed to help staff ask pregnant women the right questions, make the correct diagnoses and provide the correct treatment, but it is difficult to produce a meaningful guideline for every clinical scenario. Staffing gaps, together with stressed or inexperienced staff and insufficient review by senior colleagues, mean that cumulative risk factors arising during pregnancy or labour are often not considered when clinical decisions are made.

This leads to late diagnoses of deterioration of mother and baby (whether maternal observations, fetal growth surveillance, or intrapartum fetal monitoring), lack of escalation to more senior staff, and poor outcomes for babies and sometimes to mothers. An optimism bias and anchoring to a clinical picture that has ignored new risk factors, are recurrent themes in cases of stillbirth or oxygen deprived brain injury which may result in a neonatal death. These are the questions to ask when reviewing clinical records – not just were clinical guidelines followed for each discrete problem a mother may have had, but also was the whole clinical picture taken into account, and was this the cause of the poor outcome?

Dr Bikash Bhojnagarwala, Consultant Neonatologist

Although neonatal care has improved substantially, babies born preterm remain at greatest risk, and much of their outcome is shaped before birth. Perinatal optimisation, including antenatal corticosteroids, magnesium sulphate for neuroprotection, birth in a unit with the right level of neonatal care, delayed cord clamping and keeping the baby warm, is now measured through the National Neonatal Audit Programme, and gaps in its delivery are increasingly visible in the records.

The 14% fall in neonatal mortality among babies from the most deprived areas is encouraging; wider uptake of these measures and targeted local equity work may be contributing, although it is too early to attribute the change to any single factor.

In the cases I review, recurring themes include resuscitation at birth, delayed recognition of deterioration such as sepsis, and timely identification of babies who may benefit from therapeutic hypothermia, which should begin within six hours of birth.

Causation is often the central question: when the brain injury occurred, whether the MRI and clinical course support an acute or a more prolonged hypoxic insult, and whether earlier delivery or treatment would, on the balance of probabilities, have altered the outcome.

Taken together, the reports underline that safer maternity, and neonatal care depends not only on clinical guidance, but also on adequate capacity, timely escalation, effective communication and meaningful learning when outcomes are poor. For families and their legal advisers, careful review of the entire clinical picture, including how concerns were heard, risks were reassessed and decisions were documented, will remain essential.

Linda Napolitano, Midwife

Supporting and advocating for women and birthing people is central to the role of the midwife. That role continues when there has been a pregnancy or newborn loss. An essential part of caring for bereaved families is an honest and thorough review of the circumstances of their pregnancy and birth and the care provided.  Only with careful and sensitive review of the facts can we give families the answers they deserve, which is so vital to the grieving process.  

As midwives, we are ideally placed to look holistically at a woman’s journey through pregnancy and support families by hearing their concerns and responding candidly to their questions. In doing this we can help families to heal and restore confidence in healthcare services for their future pregnancies and their ongoing healthcare needs.

Instructing our experts

McCollum Consultants provides independent expert witnesses in obstetrics, midwifery and neonatology for clinical negligence claims involving stillbirth, neonatal death, birth injury and maternal harm. Our experts can advise on breach of duty, causation, and condition and prognosis, and accept instructions from both claimant and defendant solicitors.

To discuss a case, or to request an expert’s CV and availability, please contact:

t: +44 (0)161 218 0223

e: info@mccollumconsultants.com