You Are More Than a Number-Marta's Rule
What the Nottingham Ockenden Report means for you and how Martha's Rule will protect birthing people and families across Surrey and West Sussex.
The Ockenden Report into maternity services at Nottingham University Hospitals NHS Trust came out this week and it's the biggest independent review of maternity and neonatal services in NHS history, looking at the experiences of nearly 2,500 families. It's a really hard read.
But there are things inside it that I think every person preparing for birth or has a family needs to know. So that's what this post is about.
Labouring at home first: still a really good idea
For most women, spending early labour at home is one of the best things you can do to support your body. Being somewhere familiar, feeling safe, and having good coping tools around you can all help things move along naturally and doing the work to prepare for this during pregnancy is so, so worth it.
But I want to say this clearly right from the start: this isn't a post about physiological birth at all costs. Not at all.
What the Inquiry actually found
One of the cases in the Review involved a woman who was sent home from hospital while she was in labour. And here's the thing, the criticism wasn't simply that she was discharged at 3 cm dilated. It was that her care seemed to be based on that one number, rather than everything else that was going on for her.
She'd asked for help, more than once, she felt she needed to be there. The Review found that, looking at the full picture, she was in labour and that before she was sent home, she should have had and if she had consented to: monitoring for herself and her baby, emotional support, a review with an obstetrician, and a proper conversation about what she wanted to do.
"That's a really different message to stay home until you're 4cm."
A cervical examination is one piece of the puzzle, not the whole picture
A vaginal examination (if consented to) can tell your care giver how dilated your cervix is, but that is a snap shot, in that moment. It's only ever one part of what's happening. Good care means looking at all of you, not just one measurement.
A cervical examination is one piece of the puzzle, not the whole picture
A vaginal examination (if consented to) can tell your care giver how dilated your cervix is, but that is a snap shot, in that moment. It's only ever one part of what's happening. Good care means looking at all of you, not just one measurement.
Lots of women, after a really thorough and kind assessment, will still be best placed going home to rest. That's absolutely fine and often the right call. But it should come after proper listening, a full assessment, and a real conversation, not because a protocol says "under 4 cm, send her home."
The whole picture includes:
Your symptoms and how you feel
Your labour pattern
Your observations and vital signs
Your baby's wellbeing
Your previous birth history
Your instincts
Your emotional state
Your preferences and choices
Guidelines are there to support good care. Not to replace it.
What this Report shows us is what can go wrong when culture, leadership and accountability aren't where they need to be. When poor care isn't challenged, when learning doesn't happen, and when women aren't listened to, the consequences can be devastating.
Every single person who walks through a maternity unit should be seen as a whole person not just as a number on a cervical examination.
Martha's Rule is coming to maternity
One of the really positive things to come out of the Ockenden Report is the government's commitment to bring Martha's Rule into all maternity and neonatal settings in England.
Martha's Rule gives you and your family the right to ask for an urgent, independent review from a different clinical team if you feel your concerns aren't being taken seriously. It's built on a really important idea, that the people who know you best are often the first to notice when something isn't right.
Between September 2024 and June 2025, nearly 5,000 calls were made to Martha's Rule helplines across England and over 240 of those led to potentially life-saving interventions. It's already changing things.
Full rollout into maternity and neonatal settings is expected through 2026–27. Here in Surrey and West Sussex, the Health Innovation Kent Surrey Sussex Patient Safety Collaborative is leading the regional rollout, working with local hospitals to get this in place.
Find out now whether your local hospital has Martha's Rule. You can check your hospital's website or just ask when you're next in. It's worth knowing before your due date, not after.
And remember, even if Martha's Rule isn't in place yet where you're giving birth, you still have options. You can ask for a senior review, request a second opinion, or simply say:
"I need someone to listen to me properly."
These rights exist regardless of whether the formal scheme is up and running.
If you feel like you're not being heard
If you ever feel like your care is being summed up by one vaginal examination, please know that you can ask for more.
That isn't awkward. It isn't difficult. It isn't refusing care. It's asking for better care.
In the moment, you can speak up for yourself:
Ask your midwife or doctor: "Can we look at the full picture together, not just the examination finding?"
Say you'd like to speak with a more senior clinician if you don't feel heard.
Ask whether Martha's Rule is available at your hospital and how to use it.
Ring your maternity unit back if anything changes or gets worse after going home.
Save this. Send it to a friend who's pregnant. I really hope you never need it, but going into labour knowing that you're more than a number, and that you're allowed to ask for proper, whole-picture care, might just make all the difference.
If you'd like some support getting ready for labour and birth, including feeling confident about navigating your maternity care, I'd love to chat.
Get in touch and let's talk about how I can help.
Chantal
Birth Doula · Postnatal Doula · Hypnobirthing Instructor · Peaceful Beginnings