NMC Principles on Personalised Care and Women Birthing Outside of Guidance
News - 16/9/25
Somek welcomes the standards set last month by the NMC in relation to principles for supporting women’s choices in maternity care. The NMC has set standards for midwives in relation to:
- Situations where women’s choices of care relate to birth in hospital or at home.
- Care ‘outside of guidance’.
- Instances where midwifery care at any stage of the childbirth continuum is declined.
The term ‘birthing out of guidance’ relates to women who are requesting care that is not recommended within national and local guidance. This is usually in relation to their birthing preferences, and the most common scenario is women requesting to have a home birth when they have risk factors in which we would recommend birth in an obstetric unit. The most common risk factors include previous caesarean, raised BMI, and a history of previous obstetric emergencies such as postpartum haemorrhage or shoulder dystocia.
Women may choose to birth outside of guidance for many reasons, and it is the role of the midwife to ensure that the woman is fully informed of the benefits and risks all of her birthing options. Many midwives now utilise the tool ‘BRAIN’ to support women to have full autonomy in relation to decisions about their care: Benefits, Risks, Alternatives, Intuition, Do Nothing. Women often have had a previous traumatic birth and feel that birthing in a maternity unit will impact on their mental health and/or birth experience. The unborn does not have any legal rights until it is born, and in line with the Department of Health (2009) guidance on Consent, women have a right to decline treatment providing they have capacity: “If an adult with capacity makes a voluntary and appropriately informed decision to refuse treatment (whether contemporaneously or in advance), this decision must be respected, except in certain circumstances as defined by the Mental Health Act 1983. This is the case even where this may result in the death of the person (and/or the death of an unborn child, whatever the stage of the pregnancy).”
Previously, midwives have only been able to utilise personalised care guidance, the Montgomery ruling, and expert experience when providing their opinion on women who are opting to have care outside guidance. These new standards from the NMC provide clear guidance on the role of the midwife in these situations, and we would encourage all midwives to familiarise themselves with these principles at: