Maternal safety gains tested by midwife capacity in London
National data on maternity safety point in two directions for London providers, with MBRRACE-UK’s surveillance of babies born in 2023 reporting an extended perinatal mortality rate of 4.84 deaths per 1,000 total births across the UK and stillbirth and neonatal mortality rates of 3.22 and 1.63 respectively, while an NHS England maternity and neonatal infrastructure review published in September 2025 notes 545,149 live births in England in 2023–24, around 1,500 a day, leaving busy London units to balance modest outcome gains against high activity and increasingly complex cases.
Across the same 2019–2023 period, MBRRACE-UK’s UK perinatal mortality series shows persistent inequalities behind the headline improvements, with stillbirth rates for babies born to mothers in the most deprived areas falling to 4.23 per 1,000 total births in 2023 but remaining well above the 2.46 rate for the least deprived, and neonatal mortality for the most deprived rising to 2.50 per 1,000 live births while dropping to 1.03 in the least deprived, patterns that particularly matter in London where large Black and Asian populations face stillbirth rates of 5.84 and higher neonatal death rates of around 2.3 per 1,000 compared with 2.71 and 1.50 for White babies.
For mothers, MBRRACE-UK’s September 2025 data brief on maternal mortality in the UK in 2021–23 records 257 deaths from direct and indirect causes among 2,004,184 maternities, a rate of 12.82 maternal deaths per 100,000 maternities compared with 13.56 in 2020–22 and 10.90 in 2018–20, with thrombosis and thromboembolism the leading cause during pregnancy or within six weeks afterwards and psychiatric causes, including suicide and other mental health-related deaths, accounting for 34% of late maternal deaths, a risk profile that London maternity networks must absorb alongside fast-rising demand in deprived boroughs.
The activity and experience picture is set out in NHS Maternity Statistics for England in 2023–24, which report 545,149 deliveries in NHS hospitals over the year to 31 March 2024, a 0.4% fall on 2022–23, and show that 74.7% of babies born at 37 weeks or more had skin-to-skin contact within one hour of birth and 85.6% of women with known status reported taking folic acid before or at pregnancy confirmation, indicating that London services are delivering most core quality measures at scale even as they run continuity clinics, home visits and community follow-up around those hospital episodes.
The ability to sustain that model rests heavily on community midwifery capacity, and the Office for National Statistics’ March 2024 overview of the UK healthcare workforce, drawing on Nursing and Midwifery Council data, reports 797,928 nurses, midwives and dual registrants on the UK register on 30 September 2023, up from 693,614 in 2018, a 15% rise, while the same article notes that NHS England directly employed 1,308,825 full-time equivalent staff on 30 September 2023, 34.5% more than a decade earlier, leaving London’s community midwifery teams trying to stretch a growing but still finite workforce across dense urban caseloads and extended hours.
Infrastructure and case mix further shape how far those staff can reach: NHS England’s maternity and neonatal infrastructure review finds that fewer than half of women in England now go into labour spontaneously, down from around 70% in the early 2000s, with caesarean births rising at an average 4.6% a year and inductions at 2.9% a year since 2005, while 69% of maternity estates surveyed fail to meet current space standards and London reports 68% of its maternity and neonatal estate in the more deteriorated C or D condition bands, so community midwives in the capital are increasingly asked to manage more complex pregnancies and longer postnatal recoveries in people’s homes and local hubs even as the physical and staffing headroom to do so remains tight.
