Women must receive clearer warnings about the potentially fatal risks of home birth and should only be supported by experienced midwives, experts have said.
The calls follow a coroner’s ruling in Rochdale, England, that Jennifer Cahill, 34, and her baby, Agnes Lily, died after a home birth in June 2024 due to “a gross failure to provide basic medical care”.
Leading doctors, academics and maternity experts told The Guardian that access to safe home birth services is inconsistent and varies widely depending on location.
They said staffing shortages, inconsistent training and differing local policies make it difficult to ensure reliable care.
Kim Thomas, chief executive of the Birth Trauma Association, said: “This is an unbearably sad case of two avoidable deaths.
“We often hear from women who, having had a deeply traumatic first birth in hospital, are reluctant to give birth in hospital again. Some choose not to have another baby, while others opt for home birth.
“Unfortunately, for women like Jennifer Cahill, who had experienced numerous complications in her previous birth, a home birth can be particularly risky.
“Several things seem to have gone wrong in this case. It seems staff were reluctant to spell out the risks to Mrs Cahill, so she was not able to make a fully informed decision.”
Cahill died at North Manchester General Hospital hours after suffering a haemorrhage while giving birth at home in Prestwich on 3 June 2024.
Her baby, Agnes, was delivered not breathing, with the umbilical cord wrapped around her neck, and died days later at the same hospital.
Manchester University NHS Foundation Trust apologised and admitted there were “serious failures” in the care given to Cahill and her baby.
Her pregnancy had been classed as high-risk because she had suffered a postpartum haemorrhage – heavy bleeding after delivery – following the birth of her first child in 2021.
Cahill had been advised to give birth in hospital, but her husband, Rob, told the court that the dangers of a home birth were not fully explained.
Staff used phrases such as “out of guidance” rather than “against medical advice”, and the risk of death was not explicitly mentioned.
He said his wife chose home delivery after finding her first hospital birth “highly stressful”.
The inquest heard that both community midwives attending the birth had not seen or been aware of the Cahills’ birth plan.
Each had already worked 12-hour shifts and had been awake for more than 30 hours.
Vital notes, including blood pressure readings and the baby’s heart rate, were not properly recorded — the latter written on an incontinence pad that was later discarded.
Thomas said: “The midwives had come straight to the birth from very long shifts and seemed to lack the expertise and experience needed to handle a complex home birth.
“While we support the right of women to choose home birth, they do need the risks explained to them in full so that they can make an informed decision.
“We also believe it is unreasonable and unethical to expect midwives to attend a home birth after a 12-hour shift, when they must have felt exhausted.
“Only highly experienced midwives should attend home births where the woman has been categorised as high-risk.”
One of the attending midwives told the court there was “unease in the office” about home birth requests.
Staff were “nervous about being on call” and some “would do anything to get out of being on call”.
Dr Shuby Puthussery, associate professor in maternal and child health at the University of Bedfordshire, agreed that only experienced midwives should attend home births.
“Home births should be supported by experienced midwives with enhanced midwifery skills who are formally assessed as competent and confident to provide care for women within the home birth environment,” she said.
“While home births promote women’s choice and are becoming increasingly popular, neither reckless promotions nor blanket bans are the way forward.”
She said it was “absolutely crucial” that health professionals hold “open and transparent” discussions about “the potential for worse outcomes” if complications arise, including the time required for hospital transfers during emergencies.
“The advice to women who have medical conditions or have had a previous complicated birth, or are giving birth for the first time, is to give birth in a hospital or facility with immediate and direct access to specialist care,” Puthussery said.
Professor Asma Khalil, consultant obstetrician in London and maternal-foetal medicine expert, said the evidence about home birth risks is clear.
“For healthy women with a low-risk pregnancy who have had an uncomplicated birth before, a home birth may be suitable when supported by a qualified midwifery team.
“However, evidence shows that home birth carries higher risks for babies, particularly for first-time mothers or those with high-risk pregnancies.”
