Helping address variation in the quality and safety of care in home birth services

This week, we launched the ‘Learning from investigations where intrapartum care has been given at home’ report. The publication is based on an analysis of 59 investigation reports (produced between 2018 and 2025) which were undertaken by both the Healthcare Safety Investigation Branch (HSIB) and MNSI. The investigations related to early neonatal deaths, intrapartum stillbirths and severe/potentially severe brain injury in babies born at term following labour and maternal deaths in England.

The report shares the themes, safety observations and prompts to help improve the safety of care provided to pregnant women planning to give birth at home. The information may also be relevant to other birth settings, such as midwifery-led and hospital obstetric units.

We are very grateful to everyone who took part in the process of producing the report. From the members of staff, and women and family members, who contributed to the original investigation reports which informed our work, to those who have worked on the publication itself.

Focus on variation

We decided to place the spotlight on home births for a number of reasons. At MNSI, we are in a unique position due to the nature of our investigations, to see the neonatal and maternity care provided by many different NHS trusts in England including their home births services.

It is worth pointing out that as a programme we only investigate when there has been an unexpected outcome, and we investigate to understand the systems that support the care provided. It is once again important to stress that the majority of labours which include care and/or birth at home do not have an outcome that meets the MNSI investigation criteria.

In taking a view of the whole system, we have found there is variation across home birth services in England. We can see variation in how services are set up, how they are staffed, the training that is provided and the provision of equipment. Alongside this, there has been to date, no national standards in place for home birth services, although this is now due to be addressed by the NHS England national workstream. At the same time as our work on this began, we were also approached by Anna Madeley, lecturer in midwifery, City St George’s University of London, and we worked collaboratively to undertake the thematic analysis.

We state in the report that we do not compare outcomes across different birth settings, nor seek to influence women’s choice of place of birth. MNSI recognises the importance of informed decision-making. The report’s purpose is to share learning from completed investigations to support staff and maternity and neonatal service leaders to strengthen systems, processes and decision‑making related to home birth, alongside existing clinical guidance.

Key themes

The report’s findings are summarised into eight key themes, all of which underline the issues we have identified about the level of variation in the delivery of care. The themes include topics such as staffing availability, training standards, communication between different professionals, the assessment of risk and escalation of care needs, ambulance transfers, and the different factors within the home environment which may influence outcomes.

Next steps

It is important for families and the staff that work within these services that this report informs the raising of quality and safety standards in care and improves outcomes. The report follows on from the publication of the Independent National Maternity and Neonatal Investigation (Amos, 2026), the Independent Review of Maternity Services at Nottingham University Hospitals NHS Trust (Ockenden, 2026), and NHS England’s 10 Point Plan for maternity and neonatal services (NHS England, 2026).

The 100-day maternity safety sprint, launched by NHS England, mandates all trusts to complete a comprehensive audit of triage and safety systems, to include a review of their home birth services. In so doing, we would encourage all involved in maternity and neonatal care to consider the series of six safety prompts that have been produced as a result of the insights gained from our home births review. For quick reference, we include these safety prompts below, which are also available to view in Appendix B of the home births report. Through careful consideration and an appropriate response to these safety prompts, home birth services should be in a better position to have appropriately skilled midwives, sufficient support, and systems that enable teams to respond quickly when a woman’s or baby’s needs change.