Key themes behind midwifery fitness to practise concerns

The Nursing and Midwifery Council (NMC) has launched a new Midwifery Fitness to Practise Dashboard, offering the clearest picture yet of the recurring issues that arise when midwifery care goes wrong. The interactive tool brings together regulatory data from across the UK to highlight the concerns most frequently raised about midwives’ practice, helping the profession understand where risks concentrate and how to prevent avoidable harm.

For nurses and midwives, the message is straightforward: understanding these themes is one of the most effective ways to protect the women and families you care for, and to protect your own registration.

What the dashboard shows

The dashboard collates Fitness to Practise (FtP) concerns raised by employers, colleagues, and the public, and allows users to explore the most common allegation types and their sub‑categories. It highlights the patterns that appear repeatedly in cases where midwifery care has fallen below expected standards.

These themes are not new, but the dashboard makes them visible, measurable, and difficult to overlook.

The recurring themes behind midwifery fitness to practise cases

Communication breakdowns

Communication remains one of the most common contributors to FtP concerns. Issues include incomplete or unclear handovers, missed or delayed communication of clinical concerns, and poor communication with women and families during deteriorating situations. Clear, timely communication is a cornerstone of safe maternity care and a frequent point of failure in cases that escalate to the regulator.

Failures to escalate

The dashboard reinforces a long‑recognised pattern: delayed or absent escalation is a major factor when care goes wrong. Examples include not seeking obstetric or senior midwifery support early enough, hesitation to challenge decisions or raise concerns, and uncertainty about escalation pathways. These issues often intersect with workload pressures, confidence, and team culture.

Record‑keeping and documentation issues

Documentation problems appear consistently in FtP cases. Common concerns include missing or incomplete antenatal, intrapartum, or postnatal notes, lack of contemporaneous entries, and records that do not reflect clinical reasoning or discussions with families. Good documentation protects patients and protects practitioners when care is scrutinised.

Clinical assessment and decision‑making

The dashboard highlights repeated concerns around clinical judgement, including misinterpretation of fetal monitoring, inadequate risk assessment, and delayed or incorrect decisions during labour. These issues often arise in high‑pressure environments where early warning signs are missed or not acted upon.

Teamwork and interprofessional collaboration

Poor team dynamics are a recurring feature in FtP concerns. Examples include siloed working between midwives, obstetricians, anaesthetists, and neonatal teams, hierarchical barriers that prevent speaking up, and lack of shared situational awareness. Effective teamwork is essential for safe maternity care, and its absence is a known risk factor.

Systemic pressures and workforce challenges

While FtP cases focus on individual practitioners, the dashboard makes clear that concerns often arise within challenging environments. These include staffing shortages, high workloads, and inconsistent supervision for newly qualified midwives. These pressures do not excuse poor care, but they do shape the context in which mistakes occur.

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Why this matters for your fitness to practise

The NMC has been clear that most midwives deliver safe, kind, and equitable care every day. But when things go wrong, the consequences for women, babies, and families can be devastating, and the regulatory consequences for practitioners can be career‑defining.

Understanding the themes highlighted in the dashboard helps practitioners recognise early warning signs in their own practice, strengthen communication and escalation behaviours, prioritise documentation even under pressure, seek support when systemic issues affect safe care, and reduce the likelihood of FtP concerns being raised.

This is not about blame. It is about learning, prevention, and professional protection.

Practical steps to reduce your fitness to practise risk

• Prioritise clear, structured communication
  Use SBAR, confirm shared understanding, and document key discussions.
• Escalate early
  Escalation is a safety action, not a sign of incompetence.
• Treat documentation as part of clinical care
  If it is not written down, it did not happen.
• Maintain situational awareness
  Regularly reassess risk, especially during labour.
• Speak up about unsafe staffing or workload
  Raising concerns is a professional duty and protects your registration.

A tool for learning, not punishment

The NMC emphasises that the dashboard is designed to support improvement, not to single out individuals. It provides a national picture of where midwifery care is most vulnerable, helping the sector embed standards and strengthen safety.

For nurses and midwives, it is an opportunity to reflect, learn, and take proactive steps to safeguard both patients and professional practice.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.