Resolving this campus culture war could save lives

About how universities are inculcating dangerous ideologies into impressionable young students that fly in the face of evidence and expert consensus?

About how institutional groupthink and ideological capture are leading to real-world harm?

Good news – the health secretary is too. Except this particular culture war isn’t about gender-critical feminists or the Israel-Palestine conflict. It’s about maternity care.

A Sunday Times investigation published yesterday said that 66 per cent of UK universities teaching midwifery explicitly promote “normal birth” ideology in their curriculums – the ideology that NHS England abandoned in 2022 after it was directly linked to hundreds of preventable baby deaths across multiple hospital scandals.

Using data from HESA, the newspaper examined publicly available course materials and module descriptions from the 62 universities training more than 13,700 midwifery students in 2023-24.

It says it found an “ideological commitment to vaginal birth without medical intervention” that pervades university teaching, even as the health service itself has moved on.

At Middlesex University, it says that students are told the emphasis of modules is on “promoting normality” and how to apply that “to women experiencing complexity”. The University of Greenwich’s 445 students are said to be taught how to promote normality and the role of the midwife, which is described as “leading and promoting normality”.

Similar language on “promoting normality” is said to have appeared at dozens more institutions including Hertfordshire, Huddersfield and Bangor. At the University of Nottingham – where the local hospital is at the centre of the largest maternity scandal in NHS history – students are said to be taught about “optimising normality within complex midwifery care”.

What the NHS abandoned

The Royal College of Midwives dropped its “normal birth” campaign back in 2017, apologising in 2022 for a campaign that “may have gone too far”. NHS England abandoned hospital targets for lower caesarean section rates in 2022. This all followed a litany of devastating inquiries that all reached the same conclusion.

Former health secretary Jeremy Hunt, chipping in in the Sunday Times, recalls asking NHS England maternity leaders whether midwives were being encouraged to push too hard for “normal” births:

The answer was always to play down the concern. But my own experience told me otherwise.

If the NHS abandoned this approach three years ago, why are universities still teaching it? The answer, at least for The Sunday Times, seems to lie in regulatory failure.

Universities train to standards set by the Nursing and Midwifery Council, where the standards don’t explicitly require formal teaching qualifications for midwifery educators, and the QAA delivers quality assurance processes under contract, including programme approval, modification and monitoring activities.

In June, the Professional Standards Authority – a regulator of regulators – warned Wes Streeting that there was “significant concern” over the NMC’s ability to monitor the quality of teaching. Gill Walton, chief executive of the Royal College of Midwives, didn’t mince words in the RCM’s response to the investigation:

Right now weak and inconsistent oversight from the NMC is failing midwifery education, for those who are delivering it, for students and for women and families. The NMC’s fundamental duty is to protect the public through regulation of midwifery education and practice. We are increasingly concerned that they are not fulfilling this duty adequately.

The RCM said it has raised concerns about the quality of university education “repeatedly in recent years”, identifying weaknesses in both the setting of the undergraduate curriculum and regulatory oversight of universities delivering those programmes.

Walton’s criticism is pointed:

Our expectation is that universities do not promote an ideology of birth. Educating midwives to the evidence and making sure that they apply that evidence in practice – that’s what universities should be doing.

What students are saying

For me the most damning bit in the article is the accounts from students themselves, who describe being assessed on skills that don’t reflect clinical reality.

One student in the north of England told the Sunday Times they were assessed on 38 skills, with 27 related to normal birth and only 11 about the additional care women might need.

There’s been a lot of talk in the NHS around removing the whole normal birth ideology and outwardly I think that is happening. But as a student, in educational institutions, we are still very much in that place. A lot of us are fresh out of college and pretty much the first thing you are told about is normal birth. Our job as midwives is to prevent what they call the cascade of interventions and how that can cause problems. When you’ve got that message being given to you by lecturers, that is always going to remain in the back of your mind.”

The RCM partly blames cuts. Its own Freedom of Information request uncovered widespread funding cuts across most midwifery programmes, with the university sector facing £1.4 billion in net funding cuts in 2025-26. Almost two fifths of midwifery departments have had a recruitment freeze or undergone restructure in the previous year, with 16 per cent planning staff cuts. And the average number of staff per course has been cut by 15 per cent from 13 to 11.

Midwifery students are also being taught by staff who themselves don’t have key qualifications – fewer than half have a postgraduate qualification and 30 per cent don’t have any type of teaching qualification at all, up from 20 per cent in 2018.

For the RCM, the context helps explain why universities might cling to an outdated curriculum model – it’s easier and cheaper to teach “normal birth” as an ideal than to ensure students get comprehensive training in managing the complex, high-risk pregnancies that are increasingly common.

The regulator responds (finally)

Following the Sunday Times investigation, the NMC says it wrote to universities on Friday warning them against promoting normal birth. Chief executive Paul Rees told vice-chancellors that their courses must not deviate from the watchdog’s standards, demanding that all universities report back within a month on any courses that have been modified away from NMC standards.

Donna O’Boyle, the NMC’s acting executive director of professional practice, said:

If any university is found to be misconstruing our standards in education provision, for example around the meaning of ‘optimising normal physiological processes’, we will address that directly with them as a matter of urgency.”

That phrase – “optimising normal physiological processes” – is doing a lot of work. It appears in NMC standards, and universities appear to have interpreted it as licence to promote normal birth ideology. Either the NMC’s standards are ambiguous enough to allow this interpretation, in which case the standards need rewriting, or universities have been knowingly deviating from NMC requirements for years while the regulator failed to notice.

Neither option reflects well on the NMC. Streeting said he’s:

…working urgently with NHS England and the Nursing and Midwifery Council to overhaul midwifery training, so it reflects the complex needs of women today.

This isn’t about attacking midwives, who provide skilled and compassionate care every day, often in underfunded and understaffed services. Nor is it about dismissing women’s preferences for minimal medical intervention when that’s appropriate and safe. It’s about a mismatch between ideology and evidence, between university teaching and clinical reality, between what the NHS abandoned three years ago and what students are still being taught today.

The NMC’s belated intervention is interesting, but it raises more questions than it answers. How did two thirds of universities end up explicitly promoting normal birth in their teaching materials without the regulator noticing? How long has this been going on? What happens to the thousands of students who’ve already been taught this way (having got into a lifetime of debt for the privilege?). And why should anyone have confidence that a regulator which failed to spot this problem is suddenly capable of fixing it?

Walton’s assessment feels about right:

This is a moment for the NMC to show it can provide dependable, transparent and consistent regulation. Educators, students, midwives and families need a regulatory system they can trust.

They don’t seem to have one now. And until they do, students will keep feeling set up to fail, and babies will keep dying unnecessarily. That’s a culture war on campus that actually matters.