Launch of new MNSI thematic review: Homebirth

Background

In response to learning identified from MNSI (formally Healthcare Safety Investigation Branch (HSIB)) maternity investigations, MNSI wants to further understand how systems and pathways affect the safe delivery of intrapartum care at home. MNSI started a thematic review in 2025 to understand the themes identified from investigations where the outcome was impacted by care in labour at home or homebirth. Since starting this thematic review, there has been significant media interest in homebirth, especially following the coronial inquest and the Prevention of Future Deaths (PFD) report that was issued in November 2025. The deaths of Jennifer and Agnes Cahill were independently investigated by MNSI, and our report was shared with HM Coroner to inform their inquest.

We are hopeful that the findings of our thematic review will inform and support the work that is ongoing nationally, led by NHS England, to ‘develop further resources that enable services to consistently support commissioners, providers and women and families’, with respect to the provision of homebirth services.

Inclusion criteria 

MNSI began the thematic analysis of homebirth safety investigation reports in 2025. Reports included both HSIB and MNSI investigations from 2018 through to 2025 where a baby was born at home or any investigation where care in labour was given at home prior to transfer into an obstetric-led unit to facilitate birth. 

An initial search identified 131 reports, which were reviewed to confirm that they related to intrapartum care given at home. Of these, 71 reports were excluded as no intrapartum care was provided at home. A thematic review of the remaining 60 reports, involving 175 recommendations made to healthcare organisations across England, is now underway. Only reports where consent had been given to use the information for wider learning are included in the analysis.

Key areas of exploration in the review

The key areas below will be explored with a health equity lens in line with our wider HEWS/HEART work, to understand the impact of ethnicity and health inequalities on the care that mothers and babies receive in a homebirth setting.

1. Service provision: How do maternity services ensure the safe planning and operational decisions to support the service provision for homebirth?
2. Communication: How are families provided with accessible information and supported to make an informed decision?  
3. Equipment: Do staff have sufficient training on setting up and checking of equipment for homebirth?
4. Risk assessments: Do maternity and neonatal services have systematic pathways in place to support the ongoing holistic review and recognition of changing clinical risks of women who are planning homebirth?
5. Fetal monitoring: Do staff have sufficient training in intermittent auscultation (IA), in the escalation of concerns when there are difficulties hearing a baby’s heart rate and in the recognition of the transition between stages of labour? What are the factors that influence this in a homebirth setting?
6. Clinical escalation: How are staff supported to escalate any concerns during labour in a homebirth setting? What are the factors that influence this in a homebirth setting?
7. Care outside of guidance: How do services manage personalised care planning for those who chose to have care or birth at home outside of guidance and ensure senior multi-disciplinary team oversight?
8. Ambulance transfer: How do homebirth teams and ambulance teams work collaboratively together when a mother or baby requires urgent transfer during a labour or birth at home?

We are in the process of analysing our findings and it is intended that the results of the thematic review will be published in Spring 2026.