Objective To investigate the alignment between complaints, litigation cases, and significant untoward incidents (SUIs) at the Coombe Hospital, Dublin, following the release of Ireland’s national maternity strategy in 2016. Design A retrospective cohort study comparing complaints, litigation cases, and SUIs using statistical analysis. Setting Coombe Hospital, Dublin, Ireland. Sample The study analysed 1037 written complaints, 104 formal litigation cases, and 124 SUI reports from the hospital between 2016 and 2023. Methods Data were collected from the Quality Patient Safety Department at the Coombe Hospital, anonymized, and categorized using a hybrid system based on the Health Service Executive charter and Coombe Hospital’s complaint system. Complaints with multiple issues were assigned multiple codes. Statistical analysis was performed using SPSS software, and data visualization was completed with R’s ggplot2 library. A Chi-squared test (χ 2) was used to compare the data categories. Main Outcome Measures Identification of statistical relationships between complaints, litigation cases, and SUIs. Results There were significant differences between complaints and litigation cases (χ 2 = 221.4, p < 0.001) and between complaints and SUIs (χ 2 = 263.1, p < 0.001). However, there was no significant difference between litigation cases and SUIs (χ 2 = 4.0, p = 0.14), suggesting that similar issues trigger both legal action and classification as SUIs. Conclusions Investment in the SUI system is crucial for fostering a culture of continuous learning in maternity care. Insights from SUIs can help identify areas for improvement and potentially reduce litigation by enhancing patient safety.