The recent announcement by the government to rollout Martha’s Rule, giving families access to a second opinion in NHS maternity and neonatal services in England, marks a significant patient safety development following the damning findings in Nottingham.
Designed to empower expectant mothers, their partners and relatives with a formalised right to request a second opinion if they believe that the care provided to mother and baby is below acceptable standards, the initiative aims to ensure that concerns are listened to and that urgent medical intervention is provided where appropriate.
For women navigating pregnancy, labour and the postnatal period, understanding Martha’s Rule could make a crucial difference to the care they receive and the confidence they feel throughout their maternity journey.
What is Martha’s Rule?
Martha’s Rule is a patient safety initiative introduced by the NHS following the death of 13-year-old Martha Mills in 2021. Martha died from sepsis after complications following a pancreatic injury. Her family repeatedly expressed concerns that her condition was deteriorating, but those concerns were not escalated to a specialist for review.
Following extensive campaigning by Martha’s parents, the NHS developed Martha’s Rule to give patients and families a clear route to request an urgent medical review if they believe that a health condition is worsening and their concerns are not being fully addressed by a hospital.
Martha’s Rule means that if a pregnant woman, her partner or family member feels something is wrong during a pregnancy and up to a baby’s delivery, they now have access to an independent clinical review if they believe that their concerns are not being listened to or acted on.
Why has Martha’s Rule been extended to maternity services?
Pregnancy and childbirth are safe experiences for most families, but complications can develop unexpectedly and may quickly progress into a potentially risky situation for both mother and baby with timely medical treatment necessary.
Conditions such as sepsis, pre-eclampsia, placental abruption, haemorrhage, blood clots, and common infections like Group B Strep can sometimes occur. In these situations, families are relying on their hospital to recognise the red flag symptoms early enough to act quickly to prevent permanent harm.
The rollout of Martha’s Rule to all maternity and neonatal settings in England is expected to be completed during 2026. Giving families the formalised right to a timely second opinion, the recent announcement is a step in the right direction as patient safety in maternity wards is improved.
Research into maternity care has repeatedly highlighted the importance of listening to women and their families. In many cases where preventable serious harm occurred, mothers reported feeling that their concerns had not been fully acknowledged, and in some cases, completely ignored.
By extending Martha’s Rule into maternity services, the NHS aims to create a culture where women are encouraged to speak up and healthcare professionals are supported in responding quickly when concerns arise.
For families across England, this means an additional layer of reassurance during a pregnancy, labour and the weeks after a baby’s birth.
What does Martha’s Rule mean for pregnant women?
For expectant mothers, Martha’s Rule provides a clearer pathway to escalate concerns if they feel that their symptoms, pain levels or overall condition is worsening. This could mean noticing reduced baby movements, unexpected bleeding or just feeling that something is not quite right.
A mother may experience symptoms that are worrying even if routine medical observations appear to be normal. Under Martha’s Rule, a family’s concerns should be taken seriously and if they are not, they will have the right to request a second medical opinion.
This is a particularly important development because some pregnancy-related complications can begin with symptoms that a mother will notice first, including:
- Severe headaches
- Changes in vision
- Reduced baby movements
- Persistent abdominal pain
- Difficulty breathing
- Heavy bleeding
- Sudden swelling
- Signs of infection
The introduction of Martha’s Rule reinforces the message that women know their own bodies and that a mother’s instincts that something may be wrong matter.
How can families use Martha’s Rule in maternity care?
Under Martha’s Rule, family members can play a more active role in advocating for their loved one.
If concerns have been raised but a mother or her family members feel that they have not been adequately addressed by their hospital, they will have the right to request an escalation or second review through their hospital’s Martha’s Rule process once the rollout has been completed.
What happens when Martha’s Rule is activated?
The process may be different in each NHS trust once Martha’s Rule is fully implemented in all maternity and neonatal settings in England but the aim should be consistent.
When a concern is raised under Martha’s Rule, a pregnant woman or her relatives can contact a designated team or escalation pathway to request an urgent clinical review.
This review is typically conducted by a clinician who is independent of the immediate care team. They will assess the condition of both mother and baby, review their observations and symptoms, and determine whether further investigations, treatment or specialist medical input is needed.
Martha’s Rule acts as a safety net when families believe that their concerns are not being taken seriously or acted on quickly by maternity staff.
Why Martha’s Rule matters for maternity safety
Recent maternity reviews across England have consistently identified communication and listening failures as some of the recurring themes. This has led to too many families suffering the loss of their baby, or babies suffering permanent brain damage in entirely preventable circumstances.
Many women have reported feeling unheard when describing symptoms or expressing concerns during a pregnancy and labour.
Martha’s Rule seeks to address this issue by shifting the culture in hospitals towards a partnership between maternity professionals and the families they care for.
Rather than seeing an escalation under Martha’s Rule as a challenge to the medical team’s clinical judgement, the initiative recognises that mothers and their families can provide valuable information that should be listened to in order to improve patient safety.
For maternity services, this represents an important move towards safer, more responsive timely care to reduce incidents of avoidable catastrophic harm.
Building confidence during a pregnancy and birth
A pregnancy and labour can be an anxious time for parents, particularly for first-time mothers or women with previous experience of medical complications. Having a formal process in place for families to escalate their concerns can help to reduce some of the anxiety when unexpected symptoms are present.
Women should never feel worried about being labelled as over cautious or anxious for speaking up when they feel that something is not right during a pregnancy or labour. Martha’s Rule reinforces the principle that raising concerns is an important part of keeping mothers and babies safe and is a patient’s right.
The future of maternity care in England
The rollout of Martha’s Rule across maternity services reflects a broader commitment to improving patient safety and ensuring that women’s voices are central to their care.
As awareness grows, more families are likely to feel empowered to ask questions, seek clarification and request additional medical reviews when needed.
Ultimately, Martha’s Rule is about ensuring that concerns are heard before they become crises. For women, their partners and families throughout England, it represents a significant step towards more transparent, responsive and patient-centred maternity care.