The Hidden Risks in Maternity – Why Information Matters

In this blog, John McCann, Vice President of Global Marketing, reflects on why safe maternity care depends on more than what is happening in the moment. Drawing on conversations across the NHS, he explores how clinicians assess risk, make decisions under pressure, and later explain those decisions when care is reviewed or scrutinised – and why having the right information available makes all the difference.

Why maternity information matters for safe care

It’s important to say, up front, that for most mothers and babies, maternity care delivered by the NHS is both safe and effective, with almost 600,000 live births recorded in England and Wales in 2024 (according to the Office for National Statistics).

But maternity care sits in a unique space within the NHS. It is clinically complex, emotionally charged and subject to intense scrutiny when things go wrong. In some cases, decisions are made under pressure, with limited time, incomplete information and evolving risk. In that context, information is not just a supporting asset… it is fundamental to safe, confident care delivery in support of expectant mothers.

As such, maternity care relies on understanding what has happened before – particularly in the case of women who have had previous pregnancies. Safe care depends not only on what is happening now, but on how current events relate to a woman’s wider clinical and maternity history. Without that context, even routine decisions can become more difficult to navigate.

The complexity of modern maternity care pathways

Modern maternity care does not always follow a simple, linear pathway. Women move between community, acute and specialist services. Care may span multiple pregnancies, long timeframes and different care settings and organisations. Unplanned presentations, transfers and escalations are part of everyday reality.

Safe decision-making in maternity does not always depend on a single moment in time, but instead requires an understanding of what has come before, both in the near and longer-term. Maternity care is inherently longitudinal. It almost goes without saying that it relies on access to the expectant mother’s general medical history. Women may present across different settings, sometimes years apart, and often under unplanned or time-critical circumstances.

To assess risk effectively, maternity history is clearly important. Has the mother had previous pregnancies? Did they experience any complications? Were there any safeguarding issues clinical teams need to be aware of from previous episodes of care? Not an exhaustive list, but all of these shape how risk is assessed and how care is delivered.

What we increasingly hear is that when historical context is difficult to access, decisions become harder and potential escalations feel less certain. This issue is not necessarily the absence of information, but the absence of a clear, unified view of that information when it matters most.

How fragmented maternity records impact clinical safety

Despite the central importance of history in maternity care, access to information is not always straightforward. Historical records may be spread across multiple places, captured in different formats, or held in systems that are no longer part of day-to-day clinical workflows (such as recently replaced maternity EPRs). When time is limited, this can result in reliance on partial views or manual workarounds. This adds further pressure for frontline clinical teams who are already working in stressful environments with finite resources.

The real impact of missing or hard-to-access information often becomes visible not at the point of care, but afterwards. In maternity, clinical decisions are frequently revisited later – sometimes weeks, months or even years on – as part of reviews, investigations or learning processes. When the full picture is not readily available, it becomes harder to understand why certain judgements were made at the time.

This gap between care delivery and retrospective understanding has wider implications. To my mind, when learning depends on ‘reconstruction’ rather than ‘clarity’, opportunities to improve care are weakened. Over time, that has implications for safety, confidence and trust… both within maternity teams and across the wider organisation.

Safeguarding maternity clinicians and the organisation through reliable data

When maternity care is reviewed retrospectively, the focus is rarely limited to outcomes alone. Increasingly, attention turns to decision-making – what information was available, how risk was assessed, and whether escalation or intervention was appropriate at the time. In that context, access to a clear and complete record is as important for fairness as it is for safety.

Clinicians are routinely asked to explain decisions that were made months or years earlier – often under significant pressure at the time and with limited opportunity to reflect.

From an organisational perspective, the same challenge applies. Hospitals are expected to respond to investigations, complaints, claims and information requests with accuracy, confidence, and in a timely fashion. Doing so depends on the ease and speed with which a reliable account of care can be reconstructed, supported by evidence that is complete, consistent and accessible. Where that evidence is hard to assemble, risk increases – not just legally, but reputationally and operationally.

Safeguarding, in this sense, is not about defensiveness. It is about ensuring that clinicians and organisations are supported by the information they need to explain what happened, learn from it, and demonstrate that care was delivered thoughtfully, appropriately and in good faith.

Maternity scrutiny, reviews and accountability

Regulators and national bodies have been consistent in highlighting the challenges of evidencing decision-making once maternity care is subject to scrutiny:

Care Quality Commission (CQC)

CQC reporting has repeatedly highlighted the importance of being able to evidence clinical decisions and demonstrate how risks were identified, escalated and managed. In maternity services, inspectors consistently assess whether organisations can show clear governance, effective learning from incidents, and assurance that care decisions were informed by a full understanding of relevant clinical history.

NHS Resolution

Data from NHS Resolution continues to show that maternity accounts for a significant proportion of clinical negligence costs, often driven by the need to examine care delivered many years earlier. In 2024/25, NHS Resolution reported that £1.3 billion of the total clinical negligence payments related to maternity care – around 42% of the total clinical negligence payments.

Information Commissioner’s Office (ICO)

The Information Commissioner’s Office has noted sustained growth in Subject Access Requests (SARs), increasing pressure on organisations to locate and disclose historical information accurately and within strict timeframes. Maternity services are frequently subject to SARs, particularly following complaints, investigations or adverse outcomes.

Taken together, access to historical maternity information is no longer just a clinical concern. It has become central to how organisations demonstrate assurance, respond to challenge and maintain trust… with regulators, with patients and families, and with their own staff.

The risk of ‘doing nothing’ in maternity data management

For many organisations, the challenges described so far are not new. They have existed for years, often managed pragmatically and with the best of intentions. Information is known to exist somewhere, teams find ways to work around gaps, and reviews are completed with significant effort and manual reconstruction.

The risk lies in allowing these workarounds to become the norm. Over time, the effort required to retrieve historical information increases, scrutiny becomes more intense, and expectations continue to rise. What once felt like inconvenience begins to translate into exposure – for clinicians, for governance teams, and for organisations as a whole.

Doing nothing is rarely a conscious decision. More often, it is the result of competing priorities, limited capacity, or the belief that existing arrangements are “good enough for now”. But in maternity, where care is both high-stakes and long-lived, the consequences of that inertia compound quietly over time.

The question, increasingly, is not whether organisations can continue to manage these risks – but whether they can afford to.

Why improving access to maternity history matters now

Maternity care has always depended on good judgement, experience and teamwork. What feels different now is the environment in which that care is delivered and reviewed. Expectations around transparency, accountability and learning have increased, while the complexity of maternity pathways continues to grow. In that context, access to historical information is no longer a background issue – it is central to safety, fairness and trust.

What we are hearing consistently from across the NHS is not a call for more data, but for better access to what already exists. Clinicians want confidence that they are seeing the full picture. Governance teams need to respond to scrutiny with accuracy and assurance. Organisations are looking for ways to reduce risk without adding burden or distracting from care.

In practice, many of these challenges stem from how maternity data is stored, accessed and managed over time – particularly when care spans multiple systems, settings and episodes.

This first blog has focused on why these challenges exist and why they matter, particularly in a service as high-stakes and long-lived as maternity. In the next blog, we’ll take a look at how NHS organisations can begin to address these issues in practice – exploring some of the approaches that can be taken to improve access to historical maternity information, reduce reliance on workarounds, and strengthen safety and assurance over time.

In the meantime, if this blog resonated, sparked an idea, or provided food for thought, I’d love to hear your perspective. You can reach me on john.mccann@bridgeheadsoftware.com or feel free to connect with me on LinkedIn.

Working in tech marketing for almost 30 years, and specifically in health tech for the last 15 years, John is passionate about the issues faced by healthcare providers and is convinced that technology, when specified and implemented correctly, can be a ‘game changer’ in the delivery of patient care.

 

At BridgeHead Software, John is working to disrupt the myopia around healthcare applications instead supporting the view that data (and not applications) is the strategic asset by which patient outcomes and experience can be improved.