Expecting better: a leadership reflection on loss, inequity and the future of maternal health

To use a lived-experience account of stillbirth and subsequent pregnancy to examine how maternity care systems respond to trauma, reveal structural and relational failures in maternal health services and propose principles for more just, compassionate leadership in maternity care.

Despite advances in clinical knowledge, maternal outcomes in the UK have plateaued, with widening inequities by ethnicity, deprivation and other intersecting forms of exclusion. Maternal trauma, including stillbirth and miscarriage, is frequently minimised, poorly recognised in policy and measurement frameworks and inadequately supported in routine care. Personal experience of stillbirth and subsequent pregnancy exposes how systems that appear evidence-based and guideline-driven can fail to provide continuity, psychological safety and trauma-informed support at women's most vulnerable moments.

This reflective paper integrates first-person narrative of stillbirth, subsequent pregnancy and encounters with maternity and primary care services with professional insight from clinical and leadership roles. The reflection is informed by existing evidence on maternal outcomes, perinatal mental health, intersectionality and global trends in women's health and rights. The narrative is used as an analytic lens to explore how leadership, culture and structures in maternity care shape women's experiences and outcomes.

The reflection identifies recurrent gaps: silencing of women's voices, inadequate bereavement and mental health support, fragmentation of care and limited recognition of trauma across the maternity pathway. It highlights structural injustice in maternal health, including inequities by race, poverty and migration status, and the marginalisation of outcomes such as stillbirth and early pregnancy loss in key indicators. It proposes leadership practices that are relational, trauma-informed and equity-focused, including embedding lived experience in governance, investing across the preconception-to-postpartum continuum and prioritising culturally safe, psychologically safe care.

Leadership in maternity care must move beyond metrics and guidelines towards models grounded in humility, listening and justice. By centring lived experience, recognising trauma and addressing structural inequities, leaders can begin to rebuild trust, honour loss and reshape maternity systems to better serve women, babies, families and future generations.