What would Mary Cronk think? Midwifery, crisis and what we are losing

Today on International Day of the Midwife I'm thinking about Mary Cronk.

Mary was a fierce, tender, radical midwife who spent fifty years believing in birth and physiology, refusing to let the system forget what midwifery was actually for, and never afraid to raise her voice. She died in 2020, and the world and our profession is poorer for her absence.

Mary described the midwife as a "professional servant," a phrase I didn't feel comfortable at first, but it was a deliberate counter to the paternalistic medical model of her time: a radical act, to centre the autonomy and physiology of the individual rather than the convenience of the institution. The midwife serves the woman/birthing person, not the system.

Right now, that vision is under serious threat.

The state of midwifery in England

Midwifery in England is in crisis. Not in the way that word is sometimes used loosely, but in a painfully precise sense: the profession is losing experienced practitioners faster than they can be replaced, and the conditions that make midwifery meaningful are being systematically dismantled.

Burnout and moral injury are driving midwives out in significant numbers. The 2023 NHS Staff Survey found midwives reporting some of the highest levels of work-related distress of any clinical group. Many describe the same experience: they trained for a relational, autonomous, skilled profession, and what they find in practice is unmanageable caseloads, fragmented care, and a system in which their clinical judgement is subordinated to protocols and their time is consumed by data entry.

At the same time, newly qualified midwives cannot find jobs. In some areas there are up to three times as many graduates as there are Band 5 posts. The government's own Graduate Guarantee, announced in 2025, acknowledged the scale of this mismatch, and responded by converting maternity support worker posts into midwifery roles to absorb the surplus. Both ends of that picture tell the same story: a profession being simultaneously squeezed from above and below.

Caesarean rates and the collapse of confidence in physiology

England's caesarean section rate now stands around 43.4% nationally, with some areas reporting rates above 50% and half of all elective caesareans in some trusts are maternal request. This is a rational response to a system that has progressively withdrawn the conditions that make physiological birth possible and safe.

When women/birthing people do not feel known by those caring for them, when they arrive in labour and meet a midwife they have never seen before, when postnatal support is fragmented and rushed, when the institutional culture communicates that birth is primarily a risk event to be managed rather than a physiological process to be supported, they opt for certainty. Elective surgery, however significant, feels more controllable than a system that cannot be relied upon to hold them.

This is not a clinical problem, it is a systemic one, with clinical consequences. The 2024 Cochrane systematic review on midwifery continuity of care (Sandall et al., 2024) found that women receiving midwife continuity models were less likely to experience a caesarean section or instrumental birth, more likely to have a spontaneous vaginal birth, and more likely to report positive experiences during pregnancy, labour and the postpartum period. Cost savings were also noted in the antenatal and intrapartum periods. The review is more cautious than its 2016 predecessor on some outcomes, partly due to a broadening of the definition of continuity to include models where midwives work within obstetrically-led care — but the evidence for the relational and experiential benefits of continuity remains consistent and strong and the model is being dismantled anyway.

Breastfeeding and the postnatal gap

The UK has one of the lowest breastfeeding rates in the world. Around 73% of mothers initiate breastfeeding, but by six to eight weeks only 55% of infants in England are receiving any breast milk, and exclusive breastfeeding at six weeks stands at around 24% Nuffield Trust. Breastfeeding. The drop-off in the first days and weeks at home is where skilled, relational, continuous support matters most, and where its absence is most costly.

The evidence is consistent: breastfeeding initiation and continuation depend on timely, skilled, relationship-based support from known practitioners in the first days after birth. When postnatal care is fragmented, when the midwife who visits on day three is unfamiliar, when clinic-based contacts replace home visits for women who are exhausted, in pain, and trying to establish feeding in the most vulnerable window of all,rates fall. Not because new parents don't want to breastfeed, but because the conditions that make it possible have been withdrawn.

Birth trauma and the human cost

The human cost of all of this shows up in birth trauma rates. Research suggests that between 20 and 48% of women/birthing people describe their birth experience as traumatic, and around 4 to 5% of women and birthing people in the UK meet criteria for post-traumatic stress disorder following childbirth, roughly 25,000 to 30,000 people every year.

Again and again, the evidence shows that what determines whether a birth experience becomes traumatic is not primarily the clinical events, but how safe, supported, heard and involved the person felt throughout. Fragmented care, unfamiliar practitioners, loss of agency, rushed decisions without explanation: these are not just poor experiences. They are traumatogenic conditions. And the system is currently producing more of them, not fewer.

This is the work that brings people to birth reflection sessions. Not always the dramatic emergencies, but the ordinary failures of care: the feeling of not being known, of not being believed, of something fundamental having been done rather than shared. These are the marks that a fragmented, under-resourced, over-medicalised system leaves on people. They are preventable.

What would Mary think?

Birth units closing. Community midwifery reconfigured out of existence in some areas. Postnatal care reduced to bare minimum. Midwives redeployed into clinic-based, protocol-driven, screen-mediated work that bears little resemblance to the profession they trained for.

Mary Cronk built her practice deep knowledge of physiology, and listening to and believing in the people she served. She was furious when women were not seen. She said so, loudly, and she kept going until her last days.

I think she would be furious now.

So today, as a midwife and mother of three, I'm thinking of her. Every person who gives birth deserves to be known, not processed. Midwifery is not a data-entry function. It is a skilled, relational, autonomous profession with a robust evidence base and a long record of improving outcomes when it is properly resourced and trusted.

It is worth fighting for. Before it's gone.