Pregnancy in the UK has never been safer. In December 2016, MBRRACE, producers of the UK and Ireland'sConfidential Enquiries into Maternal Deaths and Morbidityreport stated that less than one in 10,000 women now die in or around pregnancy, the lowest rate since records began in 1952 (Knight et al 2016). Moreover, fewer than one woman in every million now dies from pre-eclampsia or hypertensive related diseases, a significant decrease since the previous report. This is in stark contrast to the daily global death toll from pre-eclampsia (World Health Organization (WHO) 2015). Historic death rates have been frequently linked to poor care. Changing practice to follow the National Institute for Health and Care Excellence (NICE) guidelines introduced in 2010 may well explain the latest low figures. This positive news means clinicians in the UK have less exposure to the danger and unpredictability of pre-eclampsia and, consequently, less experience of the necessary management should they encounter it. It is critical for us to be vigilant against complacency. Midwives are essential to further improvement efforts in the continued reduction in mortality and morbidity arising from pre-eclampsia, as well as enhancing the experience of women and families who encounter this disease. This article considers what is in a midwife's armory against pre-eclampsia, as well as reviewing ongoing research into the condition.