NHS England has mandated an urgent safety review of home birth services across the country, citing mounting concerns over inconsistent care and staffing pressures following a number of serious incidents. Issued in late 2025, the directive follows the tragic deaths of Jennifer Cahill and her baby daughter Agnes in 2024, an event that triggered a "Prevention of Future Death" warning from a coroner. This warning highlighted significant failures in the training, staffing, and oversight of midwives attending the home birth, prompting a national re-evaluation of quality assurance in this area.
The November 2025 NHS England letter requires Trusts to focus their scrutiny on several key areas. These include ensuring that midwives are properly equipped, experienced, and supported; guaranteeing 24-hour access to prompt midwifery care; and thoroughly reviewing contingency plans for potential hospital transfers associated with every home birth. Trust Boards must complete these reviews and report their findings back to NHSE regional teams.
This immediate directive occurs amidst a wider national maternity safety crisis, with services already under review due to long-standing failings within the NHS. A national maternity investigations programme, led by Baroness Valerie Amos since 2025, is actively assessing systemic issues to improve outcomes.
Experts note that, while home birth is a safe option for low-risk pregnancies, services have become increasingly fragile. Research indicates thousands of suspensions or restrictions between 2024 and 2025, mainly due to staffing shortages and burnout. This has created a "postcode lottery," where access to reliable home birth options depends heavily on local Trust provision. For instance, some Trusts, like Gloucestershire Hospitals NHS Foundation Trust, have temporarily suspended services because they could not safely cover on-call community midwifery rotas, particularly overnight. Home births currently account for under 2% of all deliveries in England.
Both the Royal College of Midwives and Birthrights are advocating for strengthened clinical oversight, clearer standards, and consistent training to ensure safety is not compromised by choice. Their stance is that planned home births for low-risk pregnancies can be empowering when supported by experienced, well-supported community midwives.
NHS England’s message to expectant parents is firm: home birth must remain a choice, but this choice must be underpinned by safe, well-resourced, and consistently monitored services. Trusts are required to identify weaknesses and take "prompt action" to ensure the service is safe for all eligible women and families. Maternity leaders are urging enhanced training, collaboration with community midwives, and effective escalation plans for hospital transfers. The outcome of these urgent reviews is expected to significantly influence the future shape of NHS home birth provision, striving to maintain a balance between personal choice and clinical safety.
