Alison Wright | President, Royal College of Obstetricians and Gynaecologists (RCOG), London; Consultant Obstetrician and Gynaecologist, Royal Free London NHS Foundation Trust, UK
Citation: EMJ. 2026; https://doi.org/10.33590/emj/30MH5A7T
Author: Alena Sofieva, EMJ, London, UK
You have said that 2026 must be the year UK maternity care moves from investigation to action. After numerous reviews and inquiries, what has prevented meaningful change so far, and what needs to happen differently now?
It is a good question, and one that is dear to my heart. There have been so many investigations, reports, and recommendations. I heard this morning that a register of recommendations from recent reports contains 1,023. It is fair to say that the system has been overwhelmed. We need clarity about what the plan should be.
What is different now is the opportunity to develop a clear action plan. I sit on the national maternity and neonatal taskforce, chaired by the Secretary of State for Health and Social Care. Representatives from the major professional groups are working alongside families with lived experience to create a joint action plan.
We have done a lot of work with service users and families, but we have not previously had this opportunity with the government leading it. We have to make the most of it by bringing together clinical, staff, and family voices, which are often saying the same thing. We all want to listen better to women and families, support informed choice, and ensure greater truth and accountability when there are unexpected outcomes.
How does this differ from previous public involvement, and when do you expect the action plan to be published?
At the Royal College of Obstetricians and Gynaecologists (RCOG), London, UK, we work extensively with our Women’s Network. Everything we do, including guidelines, patient information, education, and postgraduate exams, has input from lay members who bring lived experience or act as representatives.
That involvement has not previously been led by the government in this way. That is the key difference. The government has stated they plan to publish the action plan at the end of the year.
You have worked extensively on personalised maternity care, informed choice, and consent. In high-risk pregnancy, where clinical recommendations can conflict with a woman’s preferences, what does genuine shared decision-making look like in practice?
Personalised care means focusing on what matters to the woman or person who is pregnant, alongside their individual clinical risk factors. Throughout pregnancy and birth, any decisions need to be made with women, even when these need to be made quickly. Women should feel listened to and involved in all decisions about their care.
One of the national maternity and neonatal taskforce’s workstreams is looking at what enables us to offer informed choice. It starts with education about what might happen during pregnancy. Ideally, we would provide pre-pregnancy counselling and health education, followed by support throughout pregnancy.
It is also about personalised conversations, and clinicians need time for those. I would love to have more time to speak to people and understand what each woman wants.
Wherever possible, we need to facilitate continuity of care. Even if someone cannot see the same person every time, we can organise teams to provide that continuity. We also need accurate electronic records, so that a woman who has experienced trauma, for example, does not have to explain it to every person she sees.
How should clinicians respond when a woman’s decision conflicts with their recommendation for the wellbeing of her unborn child?
It comes back to informed choice. What worries me sometimes is that women are asked to make choices without first receiving all the relevant information.
That information must be accessible and appropriate. English may not be a woman’s first language, or she may have difficulty accessing written information, so we need to consider how we communicate it.
If she has all the relevant information and still makes a choice that differs from my advice, that is her right, as long as she has the capacity to make that decision. The Montgomery ruling is important in this discussion.
We still have work to do, particularly given the influence of social media and increasing misinformation online. As professionals, we need to ensure women have the evidence-based information on which to base their decisions.
Postpartum haemorrhage (PPH) has been a major focus of your international work with the WHO and International Federation of Gynecology and Obstetrics (FIGO). Despite being a leading cause of maternal mortality globally, many associated deaths remain preventable. Where does clinical practice still fall short?
Globally, PPH is still the biggest killer of women in childbirth, and it is largely preventable. We have seen substantial declines in PPH rates in the UK and many other high-resource countries.
I am really proud of the guidance developed jointly by the WHO, FIGO, and the International Confederation of Midwives (ICM). We came together to make clear that every professional group would stand behind these guidelines. Bringing the WHO, obstetricians, and midwives together was groundbreaking.
On 5th October, which is now World Postpartum Haemorrhage Day, we held an event at the RCOG, bringing together PPH leads from hospitals across the UK to explore implementation of best practice guidance here. We know what the guidelines say, but we need to understand the barriers to putting them into practice.
That applies worldwide. We are fortunate to have access to blood banks and medicines, but that is not the case in every country.
It will take more time to assess the impact of the guidelines. We would not expect dramatic changes yet, but I hope we will see improvements over the next few years.
Where approaches have been implemented across a whole country, as in Wales, UK. We have started to see changes in PPH rates. I am confident that we will see progress globally.
Supporting obstetricians and gynaecologists is a central priority of your presidency. What are doctors telling you that NHS leaders most need to hear?
I strongly believe that the best way to improve maternity safety and women’s health is to support, enable, and equip the doctors providing that care. Without that, we cannot expect care to be high quality, safe, compassionate, and personalised.
Obstetrics and gynaecology is particularly challenging because of workforce pressures. Caesarean rates are rising, but we are not seeing a corresponding increase in theatre capacity or staffing. Facilities and systems are not keeping pace with demand.
Unfortunately, this is leading to sickness and burnout. One study from Imperial College London, UK, showed that 80% of our trainees were showing signs of burnout. That is shocking. A significant proportion of those experiencing burnout were also showing signs of suicidal thoughts.
I am concerned for those doctors and about the impact on patient care. One manifestation of burnout is compassion fatigue, yet compassion is essential in maternity and gynaecology. We are asking staff to be more compassionate and listen more when they are increasingly burnt out. We have to support staff to improve care.
How is the RCOG adapting training to support trainees and ensure they develop the skills needed across such a broad specialty?
I would still say that obstetrics and gynaecology is the very best career in medicine, and in life. It is a privilege to be there at some of the most crucial and vulnerable moments in women’s lives, when we can make such a difference.
Most of our trainees and consultants practise both obstetrics and gynaecology, which we believe is the right approach. It is a broad specialty, with areas of subspecialisation.
An example of where we’ve adapted training to better support our trainees is through our Surgical Skills training project. As practice changes, cases are becoming more complex and service demands are higher; the need for a skilled, confident surgical workforce has never been greater. This project is delivering improvements to surgical training and standards; for example, as less major surgery is performed in gynaecology, we need to innovate through access to things like simulation training and developing surgical skills outside the operating theatre so that trainees are still getting the right experience.
Training is changing in response to women’s needs, demographics, and trainees’ needs. Through our Trainees’ Committee, we stay closely connected to what trainees feel they need and how that is evolving.
Beyond increasing capacity, what would you change about how gynaecological care is delivered in the UK?
Education is really important. We need to ensure women understand their bodies and can talk about their vagina, womb, and other body parts without shame.
My mother is now in her 80s, and when her periods started, she had no idea what was happening. We provide much more information now, but some girls and women still do not fully understand their bodies. I would like to see more education in schools, for both girls and boys, about their bodies and physiology. As part of the NHS 10 Year Health Plan, there is a shift towards a neighbourhood care model. This would mean that women can access more care in the community, including some gynaecological care that doesn’t require them to go into hospital. Contraceptive or menopause advice, for example, can be provided closer to home.
Community hubs have demonstrated the value of this approach. One hub in Tower Hamlets, UK, reduced the proportion of women referred for hospital care from 85% to 25%. This improves access and avoids long waits when women could be supported in the community.
We also need better diagnostics for conditions such as endometriosis and fibroids. Within hospitals, we are pushing for more gynaecological theatre capacity.
We talk about systemic misogyny because increasing that capacity nationally remains very difficult, and women’s health is still generally not seen as a priority. The renewed Women’s Health Strategy gives us another opportunity to maintain momentum.
What needs to change to improve access to endometriosis diagnosis?
We need to work with our Women’s Network, women with lived experience, and charities, such as Endometriosis UK, to ask whether we are pushing hard enough for research and better diagnostics.
New tests are coming through. Are we pushing hard enough for those and for better ultrasound diagnosis? A high-quality scan can detect endometriosis, whereas some scans do not. Those diagnostics are important, alongside ensuring we see women, listen to them, and do so as soon as possible.
Which areas of obstetrics and gynaecology have the greatest potential for progress over the next few years?
Robotics is perhaps the most obvious example of how our specialty is changing. We have seen some really positive advances in endometriosis surgery and surgery for women’s cancers.
Innovation is a priority of mine, but it is not necessarily about sophisticated technology. It can also mean improving how we run clinics, organise care, or design patient pathways.
There are innovations emerging in obstetrics too. For example, the is a new technique for assisted vaginal birth that we are looking at. Developments within our existing practice could really benefit women’s health.
Research needs investment, but it also needs women’s voices, so they can help shape these developments.
