Baby Loss

Andy MacNae Excerpts

Monday 13th October 2025 Commons Chamber

[Andy MacNae (Rossendale and Darwen) (Lab)]

I beg to move,

That this House has considered baby loss.

I am deeply privileged to be opening this debate in the middle of national Baby Loss Awareness Week, and in advance of the international “wave of light” on Wednesday. I want to start by welcoming the bereaved families who have joined us in the Galleries, and particularly for doing so at such a late hour: they have shown fantastic stamina in sitting through some fascinating business. I know that a number are also watching online. I have no doubt this will, for many of us, be an emotive debate that will bring back many memories, so I say this to those in the Galleries: I am grateful for your courage in joining us, and your presence lifts this whole debate and this whole day. I know that for many of you, your story is one of being let down by the system. While today cannot undo that, I hope that this national spotlight on what you have experienced, and our shared commitment to fundamental change, will be of some comfort. I also thank everyone in the Chamber for their attendance today, and for the cross-party support that the debate has received.

This is a personal topic for me and for my family. Our daughter Mallorie was born in 2015 with Edwards’ syndrome, a condition that we were told was not compatible with life; yet she lived for five days, and died in my arms. Those days were both the hardest of our lives and the time that we value most. We spent those days in the butterfly suite, a bereavement room funded by the local baby loss charity Friends of Serenity. Throughout that time, we received amazing support from the maternity team at Burnley hospital. I want to take this opportunity to thank, once again, all the team at Burnley, and to recognise the amazing work that baby loss charities do throughout the UK.

The years since Mallorie’s death have been challenging. The impacts of losing a child do not end after a week or a month or a year; they stay with us. My wife, Vanessa, suffered depression and post-traumatic stress disorder following Mallorie’s death, and has never been able to fully recover and return to her work as a health visitor. For 10 years she has had consistent difficulties in accessing sustained specialist mental health support, instead being bounced between short-term interventions and generalists. Her NHS career has now been terminated on grounds of ill health, and she is back on a five-month waiting list for therapy. Yet we count ourselves among the lucky ones. We had as good a hospital experience as we could have had in the circumstances, and time to prepare for what we knew was an inevitable outcome. We did not leave feeling that more could have been done, or that we had been let down; we felt listened to and supported in the weeks that followed.

Sadly, however, as we will hear today, far, far too many families have had the very opposite of that experience. We will hear heartbreaking accounts of babies who should not have died, of families’ concerns being belittled and ignored, of practices that fall well below any acceptable standard, and of institutional cultures of denial and cover-up. I believe that as we reach the end of today’s debate, no one will be in any doubt that addressing the long-term systemic failings in maternity care once and for all must be an imperative for this Government.

Let me start by detailing the extent of this challenge. Tragically, 13 babies die shortly before, during or soon after birth every day. Every day, 13 mothers know the immense grief of losing a child they were expecting to welcome into their lives. In 2023, there were 4,478 baby deaths in total. Some 1,933 of these were neonatal deaths, while 2,545 were stillbirths, with the cause of one third of those stillbirths still unknown. More broadly, ectopic pregnancy affects one in 80, while 240 infants die every year from sudden unexplained death syndrome, and evidence suggests that one in six pregnancies in the UK ends in miscarriage.

Crucially, these family tragedies are not shared equally throughout society; ethnic minorities and those living in deprivation are far more likely to experience this loss. This has been known for 70 years, yet little action has been taken to address it. Even in 2023, black babies were over twice as likely to be stillborn compared with white babies, while neonatal mortality rates among black and Asian babies were over one and a half times higher than the rate among white babies. Similarly, babies born to mothers living in the most deprived areas are twice as likely to die shortly after birth than those in the least deprived areas. This profound inequality must be rooted out.

These deaths occur amid a pattern of poor culture and practice in too many of our maternity wards and trusts. In its 2022 to 2024 review, the Care Quality Commission found that only 35% of maternity units were rated as “good” for safety. No units were found to be “outstanding”, and 65% were rated “inadequate” or “requires improvement”. Behind these figures lies a litany of family tragedy. In response, there has been no shortage of inquiries. Over the last 10 years, we have seen reviews or investigations into care in East Kent, Morecambe Bay, and Shrewsbury and Telford, as well as the ongoing review in Nottingham. These have revealed much and made many recommendations, yet change has not come and the cycle of failure has continued.

It is in this context that the Government have rightly decided to launch a national investigation—a systematic and urgent national review of maternity services. This is an opportunity that we must grasp, and we have a Secretary of State who I believe truly understands the urgency and importance of making it count. We have the investigation being led by a chair of the highest reputation, we have a commitment to a taskforce to deliver on recommendations, and we have many colleagues in this place who are determined to make sure that the voices of families are heard and acted on.

We must get this right, so before I hand over to colleagues, I would like to make four key asks. First, the investigation must provide clear and binding steps to achieve national change in maternity care, particularly to tackle the inequality of outcomes that is dependent on the race or wealth of the mother. To this end, the investigation must set out clear, consistent approaches to safety across all maternity units in England, which means unequivocally defining “safety”—amazingly, there is no shared definition of “safety” across maternity services. The inquiry must identify the reasons why past recommendations have not been implemented or resulted in change. It must be willing to address any embedded cultural, structural or governance factors that undermine quality, safety and accountability. When the investigation reports and the taskforce releases its action plan, the Government must fully resource the delivery and ensure there is robust monitoring and real accountability.

Secondly, it is crucial that the Government set new national maternity safety ambitions. In 2015, the then Government announced ambitions to halve relative rates of stillbirth, neonatal deaths, maternal deaths and brain injuries by 2025. Alongside that, they also announced an ambition to reduce preterm births from 8% to 6%. Those ambitions are due to expire and, in any case, were never on track to being met. It is a stark reminder of how important this issue is that 2,500 fewer babies would have died if the targets had been reached. 

The UK’s baby death rate is still considerably worse than those of the best-performing countries in Europe. To match those countries, Sands and Tommy’s have proposed new ambitions, with an end date of 2035 to align with the NHS 10-year plan. I apologise for the list, but they include a stillbirth rate of two per 1,000 total births; a neonatal mortality rate of 0.5 per 1,000 live births for babies born at 24 weeks’ gestation and over; a preterm birth rate of 6%, with disaggregated data for iatrogenic and spontaneous preterm births; and eliminating inequalities in these outcomes based on ethnicity and deprivation.

The Government’s commitment to close the black and Asian maternal mortality gap is welcome, but it must explicitly include closing the black and Asian stillbirth and neonatal mortality gaps. Establishing routine data collection on miscarriages should be prioritised. Once that is established, an ambition to reduce the miscarriage rate should be added. I urge the Government to be ambitious, and to implement these new targets, which will help to guide and inform the improvements that will be made in services in the years to come.

Thirdly, we must urgently improve bereavement care for parents in hospitals and the mental health support they receive after discharge. Losing a child is devastating, and compassionate care, both immediately and in the long term, is vital to processing grief. The national bereavement care pathway aims to standardise bereavement care, and states that this should be given by trained staff, with dedicated grieving spaces provided, opportunities for parents to have meaningful moments with their baby offered and referrals for further support made.

Since its 2017 launch, NHS trusts have gradually adopted the pathway, with full coverage achieved in 2024. However, voluntary uptake and a lack of ringfenced funding have led to highly inconsistent implementation, and sometimes it is entirely lacking. A bereaved mother described the hospital support she received as:

“Terrible. No aftercare whatsoever. I felt abandoned. My mental health spiralled due to lack of support and not knowing where to get help… I left that hospital with a broken heart.”

Bereavement support must continue post discharge. I have described the challenges that my wife Vanessa has faced in accessing specialist support, and she is by no means alone. Sands’ 2025 report found that over 80% of bereaved parents needed specialist psychological support post discharge, yet despite the introduction of NHS maternal mental health services in England, only 17% of bereaved parents were actually able to access it.

We must also recognise the additional barriers that fathers and partners face in accessing support. Only 29% of services offered basic assessments to fathers in 2024, and those are often quite perfunctory. One father explained how he was assessed and recommended for psychological interventions and a referral to a clinic, yet the only support he actually received was a leaflet outlining local self-help groups. It is not good enough, and services must recognise that fathers and partners also grieve. So I urge the Government to issue clear standards and national guidance for commissioning specialist mental health support services for bereaved parents, including fathers and partners.

Support must also be given to healthcare professionals, who can themselves be impacted by baby deaths. Training remains inaccessible for many healthcare professionals, and staff often lack the time to attend sessions. Bereavement care training must be available during work hours, and overall we must ensure staff are equipped to support grieving families and to look after themselves.

Finally, I want to touch briefly on the role of regulators, most notably the Nursing and Midwifery Council. In an area as critical as maternity safety, an effective and accountable regulator is a crucial component, yet issues with the NMC are long term and well documented. As was noted in relation to the 2024 culture review of the organisation:

“Good nurses are finding themselves being investigated for years over minor issues and bad nurses are escaping sanction because of a system that’s not functioning as well as it should.”

Such failures can have tragic consequences. For instance, the NMC cleared a midwife who had been referred to it following the avoidable death of a baby in Morecambe Bay in 2008. In 2016, the same midwife was linked to the death of another baby, and subsequently dismissed by their trust for actions fundamentally below acceptable standards. This cannot continue, and if we are to deliver on our maternity safety ambitions, we need an effective, culturally healthy regulator. The NMC still has a long way to go until it could contribute in this way. The Government must continue to offer rigorous scrutiny, demanding accountability and ensuring that the NMC becomes the regulator that nurses and midwives, as well as the public as a whole, deserve.

To sum up, each year babies die who should not have died, every year mothers are failed and harmed, and every year parents experience profound loss without the support to deal with it. We cannot continue as we are. We have both an opportunity and an obligation to act. This Government have the chance to drive a change that will be felt in the lives of families for generations. To do this, we must deliver on the full potential of a national investigation. Clear, impactful and binding actions must address systemic weaknesses and embedded cultures. To ensure long-term focus, we must also adopt ambitious, measurable targets to align with the NHS 10-year plan.

These steps to reduce baby loss must come in tandem with a compassionate system of care for those who do experience loss despite our best efforts. To this end, the Government should issue national guidance on commissioning specialist mental health services for bereaved parents. Finally, the Government must ensure the sector has capable and accountable regulators to ensure that professional standards are maintained. Taken together, we can make what has been a story of national tragedy into one of national pride, delivering compassionate and exemplary care for women and babies when they need it most. This is the challenge and the opportunity before us, and we must not fall short.

--- Later in debate ---

[Andy MacNae]

Thank you, Madam Deputy Speaker. I will speak relatively briefly. I would just like to thank everybody for their presence, honesty and passion today. This has been a moving, deeply powerful and deeply impactive debate. I particularly thank the Secretary of State, not just for being here, but for the passion, anger and urgency in his speech.

There are a million things I would like to talk about, but I will just reflect very briefly on the words of the hon. Member for Dorking and Horley (Chris Coghlan) about Billy and Billy’s parents and taking tragedy and turning that into positive change. If there is one idea that I think sums up this debate, it is the chance to take tragedy and turn it into positive change—an action that makes real difference. That is the task before us, and I thank everyone for supporting it.