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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.”
Pregnant women’s expectations about postpartum sleep may predict sleep quality after birth, outweighing prior sleep and psychiatric history, a study suggests.
The findings suggest attitudes and beliefs about sleep during pregnancy could be a modifiable risk factor for postpartum sleep concerns.
They also indicate that, among women expecting the poorest sleep, higher postpartum anxiety may further worsen sleep quality.
Sammy Dhaliwal, lead author is clinical health psychologist and research fellow in the department of obstetrics and gynaecology at the Perelman School of Medicine at the University of Pennsylvania.
Dhaliwal said: “Most pregnant women in our sample anticipated poor postpartum sleep before it occurred, and it was striking that those expectations predicted worse sleep outcomes even after accounting for factors such as prior sleep disorders, psychiatric history, and number of previous births.
“This suggests that attitudes and beliefs about sleep during pregnancy may represent a modifiable target for early intervention before postpartum sleep problems emerge.”
Sleep disturbance affects an estimated 60 to 80 per cent of postpartum women and is linked to a higher risk of depression and anxiety.
Researchers said it is often regarded as an expected part of life after childbirth rather than a health issue that may be addressed earlier.
The study enrolled 432 pregnant women at about 24 weeks of gestation, meaning around 24 weeks into pregnancy.
Participants completed measures of their expectations about postpartum sleep, current sleep quality using the Pittsburgh Sleep Quality Index, and mood using validated depression and anxiety scales.
Assessments were repeated at six, 12 and 24 weeks postpartum.
A subset of 49 women also wore wrist actigraphy devices at six to eight weeks postpartum.
Actigraphy uses a wearable device, similar to a watch, to estimate sleep and wake patterns based on movement.
The results showed that 70 per cent of pregnant women, or 301 of 432 participants, expected poor sleep in the postpartum period.
Researchers found that predicted sleep disruption during pregnancy was a significant predictor of postpartum sleep concerns.
Among first-time pregnant women without prior health concerns, those who expected greater sleep disturbance had significantly more disrupted sleep after birth, measured by both actigraphy and self-report.
Among women who expected the worst sleep quality, higher postpartum anxiety significantly worsened both measured sleep and self-reported sleep, independent of anxiety levels during pregnancy.
Dhaliwal said the findings point to two possible areas for intervention: addressing sleep-related beliefs during pregnancy and treating postpartum anxiety.
Dhaliwal said: “Postpartum sleep disruption is often treated only after problems develop, but our findings suggest there may be an opportunity to intervene earlier during pregnancy.
“Addressing sleep-related beliefs and postpartum anxiety during prenatal and postpartum care may help improve sleep and emotional well-being in new mothers.”
A weight loss jab may improve fertility outcomes in women with PMOS, early findings from an ongoing clinical trial suggest.
The proof-of-concept analysis found that injectable semaglutide may offer reproductive benefits while also addressing obesity and metabolic dysfunction.
It is the first report to examine how injectable semaglutide may improve reproductive outcomes in women with PMOS while also addressing obesity and metabolic dysfunction.
The work forms part of the ongoing RESTORE clinical trial.
Melanie Cree, professor at CU Anschutz and first author of the report, said: “Women with PMOS frequently face a frustrating choice between treatments that target reproductive symptoms and those that address metabolic health.
“Our early findings suggest injectable semaglutide may have the potential to improve both, offering a more comprehensive approach to care.
“This medication is incredibly promising when someone responds with 10 per cent weight loss.”
The trial is examining whether semaglutide can restore ovulation and improve reproductive health in adolescents and adults with polyendocrine metabolic ovarian syndrome, known as PMOS.
PMOS, formerly known as polycystic ovary syndrome or PCOS, is a hormone and metabolic condition linked to irregular periods, raised testosterone levels, infertility risk, obesity and increased cardiometabolic disease.
Cardiometabolic disease refers to conditions linked to the heart and metabolism, such as heart disease, high blood pressure and type 2 diabetes.
Existing treatments, including metformin and hormonal contraceptives, often do not fully address reproductive and metabolic complications at the same time.
The analysis focused on participants aged 12 to 35 who lost at least 10 per cent of their body weight during treatment.
Researchers said reproductive improvements appeared earlier than expected, prompting them to report preliminary findings while the wider study continues.
Cree is also a paediatric endocrinologist at Children’s Hospital Colorado.
Endocrinologists are doctors who specialise in hormones and hormone-related conditions.
Cree said: “What makes this work particularly important is that it focuses specifically on women with PMOS receiving injectable semaglutide.
“Although GLP-1 medications have transformed obesity treatment, there remains a significant need for rigorous data examining how these therapies affect fertility and reproductive function in this population.”
The RESTORE study is evaluating semaglutide treatment in girls and women with PMOS and obesity.
Its broader aim is to determine whether weight loss and metabolic improvements can restore ovulation and improve reproductive outcomes.
Ovulation is the release of an egg from the ovary, a key part of the menstrual cycle and fertility.
The authors said the findings are from an early proof-of-concept analysis and that larger, longer-term studies will be needed to confirm whether the reproductive benefits last.
The findings suggest injectable semaglutide may become a treatment option for women with PMOS seeking improvements in both metabolic and reproductive health, if future studies confirm the results.
Entrepreneur
Women’s Health Week Europe 2026 opens pitch applications for mainstage showcase at The Emirates Stadium
Women’s Health Week Europe 2026 has opened applications for its flagship start-up Pitches, giving women’s health innovators the chance to present on the mainstage at The Emirates Stadium in London on 7-8 October.
16 finalists will be selected across two categories: Medical Devices & Therapeutics and Consumer & Tech, with the shortlisted companies receiving the opportunity to pitch in front of 700+ investors, corporates, other innovators and strategic partners actively seeking solutions that can scale.
Two categories, one stage
The Medical Devices & Therapeutics category is open to companies working across medical devices, therapeutics and pharma innovation, regulated digital health, and deep-tech or science-led platforms.
The Consumer & Tech category covers consumer health and wellness brands, digital health platforms, wearables and connected data, employer and payor-led solutions, and commerce and marketplace businesses.
Any company treating a condition that affects women exclusively, differently, or disproportionately is eligible to apply.
Applications are completely free, so what do you have to lose?
Apply to pitch at WHW Europe 2026 now.
What’s in it for you?
Unmatched exposure
Present in front of 700+ investors, corporates, clinicians, and strategic partners actively seeking solutions that can scale.
With WHW Europe 2026 relocating to The Emirates Stadium and expanding to 700+ attendees across two stages, the 2026 edition represents the largest platform the series has offered to date.
A proven platform
The WHW Pitch Sessions have become one of the most commercially significant showcases in women’s health, with previous cohorts including companies that have gone on to raise investment and secure major strategic partnerships. 2024 alumni BoobyBiome, closed a £2.5M seed round in the year following their pitch at WHW Europe.
The Watchlist
All registered applicants will have the opportunity to be featured in The Watchlist, WHW Europe’s official directory of women’s health innovators to know, giving companies visibility beyond the pitch stage itself.
Applications close 28 August 2026.
Find out more about WHW Europe.
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