Learning from investigations where intrapartum care has been given at home

A new national learning report has been published setting out a number of areas in which care could be improved for women receiving intrapartum care at home.

The report provides a series of safety observations and prompts for NHS trusts on topics such as staffing availability, training and guidance, and communications between different care professionals.

The publication is based on learning and insights gained from the analysis of 59 maternity investigation reports (produced between 2018 and 2025) by both the Healthcare Safety Investigation Branch (HSIB) and MNSI. These investigations are carried out when they meet MNSI criteria and relate to early neonatal deaths, stillbirths and severe brain injury in babies born at term following labour and maternal deaths in England.

It is important to note that most labours which include care and/or birth at home do not have an outcome that meets MNSI investigation criteria. The report does not compare outcomes across different birth settings nor seek to influence women’s choice of place of birth. MNSI recognises the importance of informed choice.

The report’s purpose is to share learning from completed investigations to support staff and maternity service leaders to strengthen systems, processes and decision‑making related to home birth, alongside existing clinical guidance.

The report has highlighted eight key theme areas for trusts to consider:

1. Service provision – including staffing availability, the provision of guidance and training standards for midwives attending home births.
2. Communication and escalation – including inconsistent processes for communication and escalation which have led to delays in recognising and responding to changes.
3. Risk assessment –­ whether risk assessments are carried out and the quality of them.
4. Heart rate monitoring – addressing the process for how the fetal heart rate is monitored.
5. Recognition of evolving emergencies – the need to recognise when care needs are changing and maintaining emergency skills that are used infrequently.
6. Care delivered outside of guidelines – ensuring the appropriate guidance and pathways are in place for personalised care planning.
7. Ambulance transfer – where collaboration, communication and leadership roles were unclear, investigations found delays, duplicated actions and missed interventions.
8. Internal environment – the consideration of factors within the home environment such as lighting or positioning of a birthing pool at home.