Culture matters. In maternity services, how staff treat one another—through words, attitudes, and everyday interactions—can profoundly influence both staff wellbeing and patient outcomes. Racism, incivility, exclusion, and other forms of negative behaviour do not exist in isolation. They sit within a broader organisational culture that affects whether people feel valued, safe, and heard.

In my research on organisational learning from patient complaints, I’ve seen how underlying cultural issues often prevent services from learning when things go wrong. The same cultural barriers that silence staff can also silence patients. To create safer, kinder maternity care, we must first understand how these dynamics affect midwives, maternity support workers, and maternity care assistants—and how organisations can use feedback and reflection to bring about real change.

The Hidden Costs of a Toxic Culture

Incivility and bullying within maternity settings have long been recognised as damaging, yet they remain stubbornly persistent. Midwives and support staff often work under immense pressure in emotionally charged environments. When interactions between colleagues become dismissive or hostile, it erodes psychological safety—the sense that one can speak up, ask questions, or admit mistakes without fear of humiliation or blame.

Over time, these small moments of disrespect accumulate. Staff begin to withdraw, avoid collaboration, and lose trust in their team. The effects are not only personal but systemic. Teams marked by incivility are less likely to communicate effectively, escalate concerns, or share learning after adverse incidents. This loss of open communication can have direct consequences for the women and families in their care.

The impact can be particularly severe for maternity support workers and care assistants, whose roles are essential yet often undervalued. When hierarchies are rigid and voices go unheard, these team members may feel invisible or excluded from key decisions. Such dynamics reinforce inequality and reduce the overall cohesion of the team.

Racism and Inequity: A Layered Harm

Racism within maternity services—whether overt or subtle—adds another layer of harm. Staff from the global ethnic majority have reported being ignored, undermined, or treated differently by colleagues or managers. These experiences create chronic stress and a sense of isolation that can be deeply damaging to mental health and professional confidence.

The consequences of racism extend beyond the workforce and into the care that women receive. The most recent MBRRACE-UK report once again highlighted the stark inequities in maternity outcomes, showing that women from Black backgrounds are almost four times more likely to die during pregnancy or shortly after birth than White women, and women from Asian backgrounds face a similarly increased risk. These disparities are not the result of biological difference but of structural and cultural inequities — including how staff interact, communicate, and respond to concerns.

When staff from the global ethnic majority experience exclusion or discrimination, it not only affects their wellbeing but can also reduce the confidence of teams to discuss race, bias, or inequality openly. This silence perpetuates the very disparities highlighted by MBRRACE. A workforce that tolerates racism or fails to confront inequity risks normalising disrespect and silence. Staff who feel marginalised may hesitate to challenge unsafe practices or speak up about inequities in care, which perpetuates a cycle where both staff and patients suffer.

For maternity services striving to provide equitable, person-centred care, this contradiction is untenable. To deliver compassionate care for all women, the environment in which midwives and maternity teams work must itself be compassionate, inclusive, and fair.

Building Safer, Kinder Cultures

Improving culture in maternity services begins and ends with leadership. My PhD research on organisational learning from patient complaints showed that the behaviour of senior figures—the consultant and the matron in particular—has a disproportionate impact on team culture. Their example can either reinforce fear and defensiveness or inspire openness, respect, and collaboration. In many maternity units, their influence “trumped everything else.”

If we can engage strong, compassionate leadership from both midwifery and obstetrics, we might finally begin to make meaningful headway. The consultant’s role in shaping medical attitudes and the matron’s influence over the midwifery team are pivotal. When these leaders model curiosity, humility, and respect for others’ expertise, that tone filters through the entire service. Conversely, if either role is dismissive or hierarchical, negativity spreads just as quickly.

Leadership modelling is not abstract—it’s visible in everyday interactions: how senior staff respond to questions, how they handle conflict, and how they treat those with less power. When leaders make time for debriefs, invite contribution from all disciplines, and respond constructively to feedback, they create psychological safety. This, in turn, fosters honesty, teamwork, and learning.

Building safer, kinder cultures therefore depends less on new policies and more on visible, credible role modelling. Maternity services that unite midwifery and obstetric leadership under a shared vision—one that prioritises respect and open communication—are more likely to sustain improvement and restore trust within their teams.

Conclusion

The culture within maternity services is inseparable from the quality and safety of care. Racism, incivility, and other negative behaviours create a ripple effect—damaging staff morale, communication, and ultimately patient outcomes. For midwives, maternity support workers, and care assistants, the daily experience of disrespect or exclusion can be exhausting and demotivating.

To improve, organisations must move beyond surface-level fixes. They need to look deeply at their culture, listen to their staff, and strengthen leadership across disciplines. Every interaction, every example set by those in senior roles, shapes the tone of care that follows.

Reports like MBRRACE-UK remind us that culture change isn’t optional—it’s a matter of safety, equity, and justice. When we link organisational learning with compassion, accountability, and inclusivity—and when leaders at every level model the behaviours they wish to see—maternity services can become not only safer for women and families, but kinder and more supportive for the people who dedicate their lives to caring for them.