Read standard 1: Principles of care

Maternity standards
Healthcare Improvement Scotland

Standard statement

NHS boards ensure all women and babies have equitable, high-quality, safe and compassionate maternity care which respects their rights, preferences and choices.

Rationale

NHS boards should ensure that all women/birthing people have timely and equitable access to high-quality and safe maternity care. This is achieved through embedding a human rights approach and applying family-centred, person-centred and trauma-informed principles in line with national policy and guidance. Keeping women and their babies together is a core part of this care.

Maternity care should be responsive to each woman’s individual needs. Women are empowered and trust is strengthened when care is relationship‑based, respectful, kind and compassionate.11 Positive experiences and maternity outcomes are associated with being listened to, fully informed and having choice and control over decisions about their maternity care. Parental choice for newborn care should be respected, however, the baby’s clinical needs and best interests take precedence in line with Getting It Right for Every Child (GIRFEC) and United Nations Convention on the Rights of the Child.

NHS boards should ensure that all women have continuity of carer from a primary midwife.12 Where obstetric care is required, women should have a named primary consultant obstetrician and a consistent obstetric team. Clinical care is covered in Standards 6-11.

Throughout maternity care, women should receive clear, evidence-based information and support aligned with the national maternity pathway. NHS boards should understand and respond to each woman’s individual information and communication needs. NHS boards should ensure communication needs (including those related to disability, sensory loss and digital exclusion) are addressed. Access or signposting to appropriate translation, interpretation or advocacy services should be available in line with NHS Scotland policy.

Women should have regular opportunities to ask questions to plan and make informed decisions about their own care and that of their baby. Discussions should involve the woman’s care partner, where appropriate. Women should be offered information and access to services that promote positive lifestyle changes during pregnancy to support their own health and the health of their baby.

Where care is declined or a second opinion is sought, the woman’s choices should be respected and staff should be enabled to support her decision.3 Consent and information sharing should follow national legislation and guidance. Where there are any safeguarding issues or other protection concerns, staff should follow child protection and adult protection guidance. Integrated and personalised care plans should be co-designed with women, shared appropriately and regularly reviewed to reflect changing circumstances.

Meaningful engagement with women (and, where appropriate, their care partners) ensures maternity care is informed by lived experience, inclusive of diverse voices and responsive to changing population needs. This is achieved through a structured, evidence-based co-design approach that is continually evaluated to ensure services meet women’s needs. The impact of inequalities, barriers and discrimination can be further reduced through effective planning, delivery of services in locality areas and targeted public health messaging and interventions. See Standard 2 on addressing inequalities in maternity care.

Criteria

1.1

NHS boards ensure women and their babies have timely and equitable access to safe and high-quality maternity care that is:

• rights based
• aligned with family-centred, person-centred and trauma-informed care principles
• informed by evidence-based practice.

This applies to all women and their babies wherever and whenever they receive maternity care.

1.2

Women have positive experiences of maternity care because they are:


• fully informed and listened to
• welcomed and feel safe
• recognised as experts in their own needs and preferences
• respected in the decisions they make about their own care and their baby’s care
• supported to uphold their rights and the rights of their baby
• given meaningful opportunities to build trust with staff.

1.3

Women and their babies should not be separated unless there are evidence-based clinical, legal or safeguarding reasons that are fully discussed, documented and appropriately shared.

1.4

From birth, babies are recognised as individuals with their own legal rights and their wellbeing is central to all decisions about their care and treatment.

Women are supported to act in the baby’s best interests, make decisions on their behalf and provide the nurturing environment needed for healthy development.

1.5

NHS boards ensure women have continuity of carer by providing access to:


• a primary midwife
• a consultant obstetrician or obstetric team, when required
• specialist support from appropriate professionals, when required.

1.6

Women are enabled to make informed decisions about their maternity care,
including treatment and/or interventions, as they are supported to:


• understand the benefits and risks for any aspect of their care, including the option to decline care
• understand, and to provide, informed consent
• access data and reports of local maternity outcomes and services
• raise questions or concerns at a time and pace that is right for them
• discuss their care and options with appropriate healthcare professionals (including, but not limited to obstetric, midwifery and neonatal staff)
• understand their right to seek a second opinion or request an alternative
staff member.

1.7

NHS boards ensure women have the information and support they need to
make decisions about their own and their baby’s care throughout the antenatal,
intrapartum and postnatal periods. This includes:


• that helps them to develop the knowledge, skills and confidence to
manage their own maternity care and wellbeing
• on who to contact for concerns, advice or appointments
• support to recognise and communicate any changes in their or their
baby’s health or circumstance to their maternity team
• access to services, technology and equipment to enable independence
and support maternity care at home or in the community
• opportunities to have empathetic, informed discussions with appropriate
staff to support decision making prior to referrals being made
• signposting to relevant local or national maternity services and support.

1.8

Women have timely access to tailored high-quality information, advice and
support that is:


• accessible and responsive to their communication needs, including when additional support is required
• based on current practice and evidence and non commercial
• appropriate to the woman’s stage of the maternity pathway.

1.9

For every woman, a single, integrated and co-designed maternity care plan is in
place that:


• covers all care and support for the woman and her baby
• is regularly reviewed and updated
• documents any changes or delays in care
• reflects the woman’s physical, psychological, social, cultural and spiritual needs and preferences
• includes relevant clinical information, such as medical history, assessments, ultrasound scans and test results
• records decisions, including where care is sought outside of guidance.

1.10

Women who seek care that is outside of guidance or evidence-based practice:


• have their decisions respected in line with principles of person-centred and informed choice
• are supported to access their preferred care
• have their experiences and outcomes monitored and reviewed to ensure that they continue to receive the best possible care.

1.11

NHS boards ensure that when women (and, where appropriate, their care
partners) raise concerns, they:


• receive a timely response
• are listened to, taken seriously and treated with dignity and respect.


This includes when concerns are raised through use of bedside call buttons and when community midwifery or assessment services, or any other part of the service, are contacted by telephone.

1.12

Staff ensure women’s decisions about their and their baby’s care are
documented and shared appropriately.

1.13

NHS boards ensure that women are supported to access relevant public health interventions, including referrals, where appropriate, to:


• address concerns relating to social and economic factors such as gender-based violence, income maximisation and housing (tenancy and homelessness)
• address addiction and reduce exposure to health-harming products (including tobacco, alcohol and other addictive substances) and health-harming behaviours
• support physical health and wellbeing, including healthy eating, maintaining a healthy weight and becoming more physically active
• support mental health and wellbeing (see Standard 10)
• support positive sexual health
• attend cervical screening
• understand long-term health implications of pregnancy and birth.


This support is available throughout the antenatal and postnatal periods.

1.14

NHS boards ensure women (and, where appropriate, their care partners) have opportunities to participate in the planning, design or evaluation of maternity care services. Engagement should be:

• proportionate
• inclusive
• meaningful
• responsive to the needs of different communities, including cultural, language and additional support needs
• informed by validated engagement approaches and frameworks
• appropriately and adequately supported.

1.15

Where appropriate, care partners:


• Receive, or are signposted to, tailored information and support
• can attend appointments and the birth
• are welcomed and recognised as an important part of the woman’s support network.

What does this standard mean for...

What does the standard mean for women and their babies?

  • Your care will be based on your, and your baby’s, individual needs and circumstances.
  • You will feel welcomed and safe, and your privacy and dignity will be respected at all times.
  • You will be listened to, kept fully informed and taken seriously if you have questions or concerns.
  • You and your baby will stay together as much as possible.
  • You and your baby’s rights to safe healthcare will be upheld.
  • You will have a primary midwife who will support you throughout your maternity care. Your midwife will work with a team to make sure you get the care and support you need.
  • If you need one, you will have a named obstetrician who is responsible for your care.
  • You have the right to choose what is best for you and staff will respect your choices.
  • You have the right to accept or decline the maternity care you are offered.
  • You will be supported to act in your baby’s best interests and to make decisions on their behalf.
  • You will be asked for your consent before all examinations or interventions.
  • Information will be given in a way that works for you — at the right time, in the right format, and in a language you understand.
  • You can involve your chosen care partner as much as you wish.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace settings:

  • are empathetic, respectful and compassionate
  • provide continuity of maternity care that is safe, effective, evidence based, person centred and trauma informed
  • support women in informed decision making and the self management of their care, and provide opportunities for discussion and questions
  • support women to understand and uphold their rights and the rights of their babyshare, or signpost women to, relevant tailored information and support.

What does the standard mean for the NHS board?

NHS boards:

  • have systems and processes in place to provide equitable, high-quality and evidence-based maternity care in line with the national maternity pathway and related guidance
  • demonstrate maternity care is underpinned by a human rights approach and support women to uphold their own, and their newborn’s, rights
  • deliver maternity care that is family-centred, person centred and trauma informed
  • demonstrate compliance with information accessibility requirements, information governance, confidentiality and consent policies and legislation
  • ensure women have continuity of carer, including a primary midwife
  • demonstrate a public health approach to maternity care with referrals and pathways to appropriate interventions, when required
  • have mechanisms to record and act upon feedback from women and, where appropriate, their care partners.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the size and scale of the service or NHS board or delivery model

1.1

Board-level statements and strategies that show a clear organisational commitment to rights-based maternity care.

1.2

Documented responses to feedback from women, including feedback from patient experience surveys, complaints and Care Opinion.

1.3

Audit of any decisions to separate women from their babies.

1.4

Use of tools and frameworks (for example, BRAN) to support women to make informed decisions about their baby’s care.

1.5

Review of case records to evidence continuity of carer, including primary midwife.

1.6

Requests for second opinion or alternative staff member, with actions recorded.

1.7

Evidence of supporting women to identify and monitor their health and wellbeing needs.

1.8

 Evidence of information provided in alternative formats and languages.

1.9

Evidence of co-designed service plans.

1.10

Evaluation of maternity outcomes for women seeking care that is outside of guidance

1.11

Review of the timeliness of call handling and call-back processes in labour wards, community midwifery and maternity assessment services.

1.12

Documentation demonstrating supported decision making.

1.13

Audit of referrals to public health interventions and services, including tobacco dependency and smoking cessation services.

1.14

Tools to support women to participate meaningfully in shaping service design. For example, the Quality Framework for Community Engagement and Participation.

1.15

Policies and activities to support care partners to be involved in women’s
maternity care.

 

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project team.