Diagnosis
Women need clearer guidance on home birth risks, experts say

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.”
Pregnancy
New reporting tool targets maternal-fetal teams as pregnancy complexity rises

A new reporting tool built specifically for obstetrics and maternal-fetal medicine has launched, aimed at teams managing increasingly complex pregnancies with limited time and resources.
Trice Imaging has released Trice Workspace Reporting, which connects imaging, reporting and longitudinal patient data in a single workflow to support faster clinical decision making.
Birth rates are falling worldwide, but pregnancies are getting more complicated. Advanced maternal age, IVF-assisted pregnancies, rising obesity rates and a higher prevalence of hypertension and diabetes mean more cases now require specialist monitoring, advanced imaging and multidisciplinary care.
At the same time, clinical teams are stretched and facing growing administrative demands.
Trice Workspace Reporting brings together customisable reporting, dynamic pregnancy dating and longitudinal patient history with an AI-ready, EHR-interoperable infrastructure, all inside the company’s Tricefy image management platform.
The company says it aims to accelerate standardised and synchronised report turnaround, support timely clinical decisions and improve operational efficiency for fetal medicine services.
“Maternal fetal medicine teams are managing increasingly complex pregnancies while being asked to do more with limited time and resources,” said Mark A. Samii, chief revenue officer at Trice Imaging.
“Trice Workspace Reporting is designed to remove unnecessary friction from reporting by creating a structured digital foundation that supports today’s need for connected clinical workflows.
“It also provides a digital foundation as practices prepare for tomorrow and the evolution of AI-enabled fetal assessment, anomaly detection and outcome prediction technologies.”
Trice Imaging describes its mission as transforming the women’s health journey by connecting physicians, patients and healthcare systems. From independent practices to large hospital ecosystems, it aims to reach the entire women’s health continuum, spanning IVF and reproductive health, maternal-fetal medicine and OB/GYN, and onwards to lifelong women’s health.
For more than 17 years the firm has worked on cloud-based storage, retrieval, display, organisation and exchange of ultrasound medical images and associated information across health environments.
Its wider platform now extends to dynamic clinical reporting, AI-driven workflow optimisation, data analytics and secure patient engagement.
Trice Imaging holds regulatory and data protection clearances in 40 countries. It has offices in Miami and Stockholm, alongside a growing network of global distributors.
Diagnosis
Two “gamechanger” tests set to speed up endometriosis diagnosis on the NHS

Two endometriosis tests could cut years from diagnosis after NICE backed their temporary NHS use in England and Wales.
EndoSure and Endotest have been recommended in draft guidance, with one able to provide results in 45 minutes.
Endometriosis affects around one in 10 women of reproductive age. It occurs when tissue similar to the womb lining grows elsewhere, including around the ovaries and fallopian tubes.
Symptoms can include painful periods, painful bowel movements, pain when urinating and pain during or after sex.
Diagnosis can involve ultrasound scans, magnetic resonance imaging (MRI) or laparoscopy. A laparoscopy is keyhole surgery in which a camera is inserted through a small cut in the abdomen.
Despite the effect the condition can have on physical and mental health, women can wait years for a diagnosis.
The average wait in the UK is nine years and four months, rising to 11 years for women from ethnically diverse communities, according to the National Institute for Health and Care Excellence (NICE).
Long waits can increase suffering, prolong poor health and allow the condition to progress, making it more difficult to treat.
Dr Anastasia Chalkidou, NICE’s healthtech programme director, said: “A diagnosis of endometriosis can for some women take the best part of a decade, with the UK average standing at nine years and four months, and rising to 11 years for those from ethnically diverse communities.”
She said delays could lead to chronic pain affecting daily life, relationships and work.
She added: “These technologies have the potential to change that by giving primary care professionals better non-invasive tools to identify endometriosis earlier, allowing earlier and better treatment.
“Our draft guidance reflects our commitment to getting promising innovations to patients quickly, while making sure the evidence to support their wider use is built in a rigorous way.”
Endotest examines a saliva sample for microRNAs, tiny biological markers that can indicate the presence of endometriosis.
The sample is sent to a laboratory and the result returned to a GP or another healthcare professional to inform the next steps in diagnosis and care.
EndoSure uses sensor pads placed on the abdomen to measure electrical signals in the gut.
Women must fast for between six and eight hours before the 45-minute test. During the procedure, they drink water until they feel full, helping the device record gut activity accurately.
Results are available as soon as the test is complete.
The draft recommendation, published on Tuesday, approves both technologies for three years while further evidence is collected on how well they work.
NICE will then decide whether to approve them permanently for NHS use.
NICE said a third test, DotEndo, needs more research before it can be recommended.
EndoSure and Endotest are not designed to diagnose the condition on their own.
They are intended for women whose symptoms still suggest endometriosis after a normal clinical examination and negative or inconclusive imaging results, or when imaging has not been carried out.
Dr Gail Busby, a consultant gynaecologist at Manchester University NHS Foundation Trust, said: “These tests are a gamechanger because they give us answers much earlier, without the need for invasive surgery, and that means we can start the right treatment sooner.
“An earlier diagnosis doesn’t just change one person’s life, it frees up appointments and surgical slots for everyone waiting for care.”
Emma Cox, of Endometriosis UK, welcomed the tests.
She said their introduction should be supported by education for GPs and nurses to ensure prompt access and prevent symptoms from going unrecognised.
Entrepreneur
Xella launches AI-powered precision health platform

Xella Health has launched what it calls the first AI precision health platform built for the XX chromosome.
The company says it aims to address a lack of diagnostic precision and clinical research focused on female biology.
Women make up half of the population and account for 80 per cent of consumer healthcare decisions, but research into women’s health has historically received less funding than male-focused studies.
Kelly Lacob, Xella Health co-founder and chief executive, said: “Women have been trapped in a diagnostic dark age experiencing debilitating symptoms like severe period pain, bloating and GI issues, exhaustion, and brain fog, routinely dismissed by the healthcare system.
“This dismissal results in women being diagnosed four years later than men, on average, for the same conditions, and a seven-to-10-year delay for women to receive an accurate diagnosis for conditions like endometriosis.
Stalling necessary care and treatment results in prolonged suffering with chronic pain, heightened infertility risks, and declining mental health.
Xella is here to replace the systemic medical gaslighting women have endured for generations.
We are handing women the evidence and information they need to advocate for themselves and secure faster, accurate diagnoses before early-stage conditions spiral.”
Xella says its AI examines billions of data points from clinical information and multi-omic biomarkers to assess the probability of more than 130 conditions specific to female biology.
Multi-omic data combines information from several biological areas, including genes, proteins and hormones.
The conditions assessed include polyendocrine metabolic ovarian syndrome, or PMOS, formerly known as polycystic ovary syndrome, as well as perimenopause and endometriosis.
Xella was founded by Lacob, Adriana Dantas and Dr Jesus Ching, who developed the concept while working together on molecular diagnostics at Mammoth Biosciences.
The founders say the platform is designed to provide information about possible underlying causes through advanced testing and long-term care of a kind often available only through expensive concierge services.
They drew on personal experiences to build a service intended to identify small changes in a woman’s biological baseline.
Members complete an initial health questionnaire before having blood taken at a local partner laboratory such as Quest or Labcorp.
A phlebotomist can also visit a member’s home for an additional charge.
The company’s AI analyses biomarker data from genomics, proteins and hormones alongside symptoms, lifestyle risks and medical history.
Xella says this information is used to screen for more than 130 female-specific conditions, including PMOS, Hashimoto’s disease, premenstrual dysphoric disorder, endometriosis and perimenopause timelines.
Hashimoto’s disease is an autoimmune condition in which the immune system attacks the thyroid gland.
Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome that can cause significant emotional and physical symptoms.
The results are processed through Xella’s own dry laboratory, which the company says is certified under the US Clinical Laboratory Improvement Amendments and accredited by the College of American Pathologists.
A dry laboratory analyses data using computing and other non-experimental methods rather than carrying out traditional laboratory procedures.
The findings are turned into a personalised healthcare plan and reviewed with a certified telehealth doctor.
The doctor may recommend immediate clinical action, including personalised hormone therapy or referrals to genetic counsellors, pelvic floor physiotherapists and reproductive endocrinologists.
Reproductive endocrinologists are doctors who specialise in hormones, fertility and reproductive health conditions.
Dantas, co-founder and chief operating officer, said: “Women’s health data has historically been treated in isolated silos – a hormone test here, an ultrasound there – but no one was connecting the dots across the entire biology.
“By tracking unique biological patterns longitudinally across cycles and life stages, we aren’t just providing data, but a clear path forward.”
Xella’s clinical advisers include Dr Allison Kurian, director of Stanford Women’s Clinical Cancer Genetics Program and professor of medicine, epidemiology and population health at Stanford.
They also include Dr Lynn Westphal, a reproductive endocrinology and infertility specialist and chief medical officer of Kindbody.
Xella has received US$4.7m in angel and pre-seed funding from Precursor Ventures, Capital F, Ulu Ventures and Swizzle Ventures.
Other funds and angel investors from healthcare, diagnostics and consumer technology also participated.
Margaret Coblentz, co-founder and general partner of Capital F, said: “Women’s health is one of the highest-momentum categories in the market today, driven by a US$15tn female economy.
“Xella represents exactly how Capital F sees women’s health evolving: deep clinical expertise paired with a consumer-first mindset, and a genuine opportunity to unlock the next generation of healthcare.”
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