Why “Patient Safety” Falls Short and What We Must Do Instead
Introduction: Time for Change
In healthcare, 'patient safety' is a foundational concept (Institute of Medicine, 2000). Preventing harm and promoting high-quality care are essential. In maternity care, the term patient safety is embedded within a medicalised, hospital-centric model that can be at odds with midwifery philosophy and the experiences of birthing women.
We must ask: Safe for whom, and by whose definition? This blog post argues for
a shift in safety culture; from a focus on protocols and risk aversion to one
that centres each woman’s wellbeing and safety in all its dimensions.
Please note: throughout this blog post, I use gendered
language (e.g. “maternal,” “mothers,” “women”) with the acknowledgement that some
who give birth do not identify as women.
The Problem with 'Patient Safety' in Maternity Care
The term 'patient safety' emerged from a
hospital risk-management paradigm focused on preventing clinical error
(Institute of Medicine, 2000). It assumes that the care recipient is ill,
passive, and dependent, and that safety is achieved through compliance and
protocol.
This framing is a poor fit for maternity care. Childbirth is not an illness.
The majority of women are well, and the birthing process, when supported
physiologically and respectfully, often unfolds safely without intervention (Consensus
statement, 2013). The term patient
strips women of agency, embedding a power imbalance, positioning them as objects of care, rather than autonomous participants. It reinforces a culture where
decision-making is top-down and where deviation from protocol is seen as
dangerous, regardless of the woman’s values or the context. Safety in this context is too often
reduced to physical outcomes alone. While survival is of course paramount, the ‘patient safety’ focus on physical outcomes neglects emotional,
psychological, cultural, and relational safety, all of which profoundly impact
a woman’s experience and recovery (Bohren et al., 2015).
Consequences of a Misaligned
Safety Culture
- Over-medicalisation: Risk-averse environments may lead to unnecessary interventions that increase morbidity and trauma (Birthrights, 2013).
- Disempowerment: Women may be coerced, ignored, or denied informed choices “for their own safety” (Keedle et al., 2022).
- Moral injury among midwives: Midwives may be unable to practise in ways that align with their professional knowledge and values (Kendall‐Tackett & Beck, 2022)
- Structural harm: Racism, cultural insensitivity, and obstetric violence are often overlooked in traditional safety audits (Hailu et al., 2022).
A Midwifery-Informed Vision:
Woman’s Wellbeing and Safety
- Holistic: centring the whole person, physical, emotional, cultural, and social (O’Reilly et al, 2025).
- Embracing partnership and informed decisions (Esteban-Sepúlveda et al., 2022)
- Valuing continuity of care and trust (Homer, 2016).
- Recognising women’s right to define their safety. (Rönnerhag et al., 2018)
- Safety, in this sense, is not the absence of clinical error: it is the presence of respect, choice, connection, and support (Lyndon et al, 2018)
Practical Steps Toward
Reorientation
- Replace “patient safety” with “woman’s wellbeing and safety.”
- Value relational safety and continuity of care.
- Embed emotional, psychological safety and Cultural Safety as essential elements.
- Foster reflective, non-punitive team cultures.
- Involve women in defining what safe care means.
Conclusion
True safety in maternity care cannot be
achieved by clinging to a model that sees women as patients and care as
something done to them. We must shift from a safety culture of control
and compliance to one of trust, relationship, autonomy, and respect.
Language is not neutral and by choosing to centre each woman’s wellbeing and
safety, we take a meaningful step toward care that is not only safer but
also more just, more respectful, and more human. Safety in maternity care must
move beyond checklists and compliance. It must be woman-defined, relational,
and holistic. The term “patient safety” no longer serves us — if it ever did.
By reorienting our language and our culture toward each woman’s wellbeing and
safety, we honour not only midwifery values but the human dignity of every
woman giving birth.
Let us choose our words and our paradigms wisely. They shape the care we
give.
What do you think? Do you agree? Do you disagree?
References
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