Supporting expectant parents' choices about where and how to give birth raises operational challenges for maternity services in England which are already under considerable pressure and scrutiny. The challenges have been highlighted by inquests following a series of tragic deaths, three of which have resulted in Prevention of Future Deaths (PFD) reports that demonstrate recurring systemic gaps. 

This article considers what those reports reveal and what healthcare organisations can do in the absence of definitive national guidance.

The current challenges

The challenges faced by NHS maternity services in England in safely supporting expectant parents  choice in choosing where and how to give birth has come under intense scrutiny following a series of tragic deaths following home births. Three of these inquests (arising from the deaths of Matilda Pomfret-Thomas, Jennifer and Agnes Cahill and Pippa Gillibrand) have resulted in Prevention of Future Death (PFD) Reports which identify a number of similar issues including:

1. An absence of national guidance in respect of home births 

Whilst home births are covered in NICE Guidance on intrapartum care 2023 (updated November 2025) there is no standalone national guidance in respect of home births. Both NHS England and both the Department for Health and Social Care acknowledge that the current intrapartum guidance does not provide the necessary clarity to support women, staff and services to support home birth requests safely and steps are being taken to develop resources to close this gap (see below).

2. Lack of a model of care for midwives supporting home birth care

There is an increase in the number of women with high-risk pregnancies requesting home births where required interventions cannot take place or would be significantly delayed. However, there is no robust framework or national guidance for midwives supporting home birth on key issues such as the training needs and support needed for midwives attending home births; the threshold for transfer to hospital; safe staffing and equipment levels, without which the service should be suspended; and a system for back-up should electronic systems fail.

3. Shortcomings in informed consent

The PFD reports (and other neonatal inquest conclusions) highlight the importance of clear, ongoing, conversations with women (both antenatally and during labour) about birth choices and risk. These need to be two-way conversations, with active listening by staff to enable them to understand the factors impacting on a women’s decision making (for example, is there a fear of a hospital delivery linked to previous birth trauma) and also clearly communicate material risks and alternative options in a way that expectant parents can understand.

In the context of consent, the language and terminology used to communicate risks is also critical. In one PFD report, the Coroner noted that "the language used with women is delivered in a softer, kinder way and uses phrases such as out of guidance rather than simply ‘against medical advice’ as would be the norm in other areas of medicine". 

Although there is a very small risk of death, this is not something which is discussed with women particularly in relation to maternal death, even if the woman has a recognised risk such as a post-partum haemorrhage. In this respect, it is also noted that the NICE guidance on intrapartum care focuses on the potential risk of death to a baby rather than to the mother. In addition, terminology around pregnancies describes them as 'high' or 'low risk' and may lead women to consider that pregnancy encompasses all stages through to delivery of a child. 

The cases all highlight the importance of providing personalised information about material risks, reviewed and updated throughout the pregnancy and labour so that expectant parents can fully understand what the level of risk is for them and their partners.

4. Lack of data collection

There is no national or local collection of data around home births, such as the number resulting in transfer to hospital during labour or after birth, the number of women considered to be option for care ‘out of guidance’ or the number involving injury to mother or baby. One Coroner suggested that this data might assist expectant parents in understanding the risks and make informed choices.

The future

In November 2025, following the inquest into the sad deaths of Jennifer and Agnes Cahill, NHS England wrote to all NHS maternity provides in England asking them to review safety and quality of their home birth services with a focus on operational running of the service, care planning and risk assessment and governance and oversight. 

NHS England are proactively working with partners including NICE, the Royal College of Midwives, the Royal College of Obstetrics and Gynaecology, the Nursing and Midwifery Council, Maternity and Newborn Safety Investigations, the Care Quality Commission, and the General Medical Council to develop further resources that enable services to consistently support commissioners, providers and women and families. 

As part of this, in its response to the PFD report relating to the deaths of Jennifer and Agnes Cahill, NHS England stated that it "will also consider the ethical responsibility and proportionality of offering women an NHS home birth, while taking into account that women have a legal right to choose what healthcare they receive. In addition, some women who cannot be supported to birth at home due to the level of risk may choose to give birth unassisted, which carries a higher risk. We will build on work already started, looking to clarify whether NHS health professionals providing maternity services may withdraw midwifery services from women birthing at home against professional advice and/or from women making requests with regards to care/treatment that are considered highly unsafe or unreasonable".

Indeed, over the last few years, some Trusts have temporarily suspended or withdrawn their home birth services due to safety concerns. However, this is understandably a contentious issue and has led to concern is that women may be left without any professional support posing greater risks to them and their babies.

Bridging the gap: What should healthcare organisations be doing

In the context of the recent inquests, system pressures and wider scrutiny on maternity services, the development of resources to assist Trusts in supporting women’s choice for a home birth is welcome.

However, national guidance will take time to develop so Trusts should be continually reviewing their services and where appropriate taking steps to strengthen care planning processes, ensure robust informed consent, address any staffing and equipment gaps.

Staff should also be supported and given appropriate time to listen empathetically to women's concerns, provide unbiased and comprehensive information on all birth options, and respect each women’s right to autonomy. Access to training in informed decision-making and risk communication may also be helpful.

Helpful resources

We covered some of these issues in our Shared Insights maternity forum on ‘Birthing outside guidance’ in July 2025 and the note of this session might be useful for Trusts to review. 

We understand that maternity services are under considerable system pressure and that the final report of the Independent Investigation into Maternity and Neonatal Services in England will shortly set out recommendations for significant changes to the delivery of maternity and neonatal services in England.

We provide practical training to support organisations and clinicians to improve consent and supported decision-making processes and have developed a virtual training bundle, delivered by Browne Jacobson's risk management and maternity experts, to empower healthcare organisations and clinicians with the knowledge to ensure informed consent, reducing legal risks and improving patient care. This paid for on-demand webinar includes insights, lectures and case studies. If you would like more information about the training package please contact us.