NHS England is considering allowing midwives to “withdraw” services from women deemed to be giving birth at home against professional advice, HSJ has learned.
The Royal College of Midwives has warned that if this advice is introduced, it risks “push[ing] women towards giving birth entirely alone, [presenting] far greater risk to mother and baby”.
The disagreement comes as NHS services urgently seek clarity from system leaders on how they should best support home births and some high-risk pregnancies.
However, the advice would also cover how services should respond to other care and treatment requests that are considered “highly unsafe or unreasonable”.
NHS England’s discussions about the potential new advice were revealed in a letter responding to a coroner’s Prevention of Future Deaths report.
The letter is dated 24 December, but it was only published last month, and HSJ understands a definitive decision about the advice has not yet been made.
The letter said: “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.”
It added: “In developing [better home birth resources], NHSE and its partners will 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.”
The report prompted chief midwifery officer Kate Brintworth to order all trusts to “urgently” review the safety of home birth services in November.
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Source: HSJ, 28 April 2026
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