The Nottingham Ockenden Report was published on 24 June 2026. If you have not come across it yet, here is the short version: it is an independent investigation into maternity and neonatal care at Nottingham University Hospitals between 2012 and 2025, covering nearly 2,500 families, and it is the largest maternity inquiry in NHS history. At the end of it there is a list of actions that maternity services across England are now expected to implement — standardising escalation processes, Martha’s Rule, cultural and linguistic safety, workforce race equality, governance reform, postnatal care standards. We want to talk about that list honestly, because you deserve honesty more than reassurance.
Martha’s Rule is the right to ask for an urgent second clinical opinion if you feel your concerns are not being heard. Know about it. Use it. Tell every pregnant person you know that it exists. And also know what it was built for: a system in which someone at the other end will hear you and act. This report documents that Black and Brown women and birthing people are not currently operating in those conditions. Women were not believed. Concerns were dismissed. The report describes covert racism in the way care was delivered at NUH, and it notes that global majority families were so afraid of and mistrustful of the system that they could not bring themselves to engage with the review. The system harmed them and then could not hear them name it. Martha’s Rule is a tool and it is worth using, but a procedure for being heard does not work inside a culture that has already decided not to hear you — and that is the culture this report has just spent hundreds of pages documenting.
Black women in this country are 2.3 times more likely to die in childbirth than white women. That is from national data published in 2025. It is not a Nottingham-specific figure and it is not historical. It is the picture today, across England, and it is not improving. In the essential actions, cultural and linguistic safety and workforce race equality appear as two items on a list of six, given equal weight to governance reform and postnatal discharge standards. We want to say plainly what that means: structural racism is being treated as one problem among several rather than as the condition the entire maternity system is operating inside. The reason Black women are not believed, the reason their concerns are dismissed, the reason global majority families could not engage with this review — that is structural racism. It is not parallel to the other problems. It is underneath them. Listing it as one action among six and expecting the list to close the gap is not a plan. It is what has been tried before, and Black women are still at 2.3 times the risk.
If you are pregnant right now, you are not waiting for implementation. You are in this system today. So here is what we want you to know. You have the right to be believed, and if you are not being believed you have the right to say so, to ask for a second opinion, to request a different midwife or clinician, to have someone with you who will speak on your behalf and document what happens. You have the right to an interpreter, a trained interpreter, not a family member pressed into the role under pressure. You have the right to be at the centre of your own care. A justice-informed doula cannot fix the NHS. That is not what we are here for. What a doula can do is stand beside you in that system, know the landscape, know when and how to escalate, and be entirely and unambiguously on your side.
Every person we train at Abuela Doulas learns what this report documents, not as background reading but as current conditions. The system is not neutral. Your clients cannot afford for you to pretend otherwise. And the families who drove this inquiry, who turned private grief into collective action because they decided what happened to them should not happen again, deserve more than a list of actions. They deserve a response as serious as what they survived.
We are still here. We are still training. Find us at www.abueladoulas.co.uk.
According to the latest MBRRACE-UK Saving Lives, Improving Mothers' Care report (covering 2021-2023), Black women are 2.3 times more likely to die during or up to a year after pregnancy compared to white women
The Disparity: While the mortality rate for Black women has shown some decrease from earlier figures (it was previously 3.7 times higher), the stark racial disparity remains critically elevated.Asian Women: Women from Asian ethnic backgrounds are 1.3 times more likely to die compared to White women.Overall Rate: The general UK maternal mortality rate is 12.82 deaths per 100,000 women giving birth.
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