The Nottingham University Hospitals NHS Trust report has identified serious failings in care at one of England’s largest maternity services, with lessons for maternity units nationally. Among its findings was a repeated problem at the very start of labour: women and families struggled to access timely assessment and felt dismissed during telephone triage.

In several cases, women were discouraged from attending hospital when they believed labour had started, only to arrive later in established or advanced labour. In some cases, poor care during this period had serious consequences.

Across hospital-based maternity services, attention and resources tend to focus on women in more advanced labour, and those requiring induction of labour or caesarean section. This can mean services miss the chance to identify problems, offer reassurance and build trust at the very start of labour.

Listening to women and providing supportive care at the start of labour sets a woman up for a positive birth experience. Instead, research consistently shows that women report feeling unsupported and discouraged from coming to hospital in early labour.

Right at the start of labour, there is often a mismatch between the needs and expectations of women and the expectations and priorities of maternity services. Many women have long been told that hospital is the safest place to give birth. It is therefore unsurprising that they expect to be welcomed to the maternity unit where they are booked to give birth when labour starts.

The drivers of decision-making on the maternity services........

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