In June, I was honoured to attend the International Confederation of Midwives (ICM) Congress in Lisbon on behalf of the Royal College of Nursing (RCN). This triennial event brings together midwives, educators, researchers, policy leads and midwifery associations from around the world to share learning and work collaboratively to address common challenges.

The theme of this year's Congress was the need for one million more midwives. Globally, midwives provide over 90% of sexual, reproductive, maternity, neonatal and adolescent healthcare, working to provide education, improve health outcomes and prevent long-term complications. Yet, worldwide, a woman dies every two minutes from pregnancy- and childbirth-related complications. An estimated 4.6 million women, girls and babies could be saved if there were enough midwives.

The week was both inspiring and humbling. Topics ranged from educational simulation to support breech birth, to developing the skills needed to be heard as a leader. The important role of Indigenous midwives was something I had not previously encountered. From the South Pacific to the far north of Canada, these women work within their communities to rebuild trust in healthcare while embodying and preserving their cultural heritage. One sobering moment was recognising the barriers faced by many midwives in attending the Congress – not merely the cost or distance involved, but also the diplomatic and political challenges that can affect international travel.

I was reflecting on my experience in Lisbon when Donna Ockenden's independent review into Nottingham University Hospitals NHS Trust maternity services was published. The findings were tragically familiar. Mothers and babies were harmed by a service where short staffing, inadequate estates and insufficient equipment had become the norm. Exhausted and overstretched midwives followed local culture and outdated guidance rather than being supported to deliver evidence-based care. Families were not listened to, and the reputation of the Trust was prioritised over learning from serious incidents.

Those affected will never forget their unimaginable loss, and we all believe that this report must represent a watershed moment for UK maternity care. All staff working in maternity services – midwives, nurses, doctors, allied health professionals and support workers – must be confident that they have the support, resources and facilities required to provide high-quality, family-centred care. Women and their families must have meaningful, informed choice regarding their care, have their decisions and concerns respected, and be able to seek a second opinion when needed.

There are clear similarities between the challenges faced globally and those encountered nationally. While the context may differ, what is evident is that maternity services often suffer from a dichotomy of "too little, too late" and "too much, too soon". In some parts of the world, women in desperate need cannot access vital maternity services because of cost, geographical distance or a lack of professional care. In other settings, care is highly medicalised and almost entirely hospital-based, with routine caesarean births and the separation of newborn babies from their mothers.