Read standard 4: Service planning and facilities

Maternity standards
Healthcare Improvement Scotland

Standard statement

NHS boards ensure services and facilities deliver safe, high-quality maternity care.

Rationale

NHS boards should ensure maternity care is accessible and provided as close to home as possible. Where a woman/birthing person has to travel to receive maternity care, NHS boards should provide clear, accessible and fair policies for reimbursement of reasonable expenses in line with national guidance.

NHS boards should ensure robust systems and processes are in place to support the safe delivery of maternity care in all settings. This includes care delivered through midwifery-led and obstetric-led units, community midwifery services, multidisciplinary community hubs, and telemedicine. Arrangements should be in place to ensure seamless, coordinated care and to support the safe, timely transfer of women and their babies.3, 21, 22

All clinical and non-clinical environments should be designed to support trauma-informed care, uphold privacy and dignity and to meet the diverse physical, sensory and communication needs of all people using the service. Services should be configured to offer a range of birth options and environments (including home births), promote active labour and birth and enable maternal mobility. Non-clinical areas should be welcoming and, where possible, support family-centred care. Maternity care should be planned and delivered to ensure it is accessible, equitable and person centred. Services should be responsive to the different needs of women at all stages of pregnancy and throughout the postnatal period in line with the national maternity pathway and related guidance.

NHS boards should ensure timely access to a fully-equipped and appropriately staffed obstetric operating theatre located within, or immediately adjacent to, the labour ward. Robust contingency plans should be in place to manage situations where simultaneous obstetric emergencies require simultaneous theatre access.

NHS boards should ensure effective infection prevention and control (IPC), regular environmental monitoring and the provision of well-maintained facilities and equipment. Maternity staff providing care in the woman’s home, including during home births, should continue to follow IPC national procedures and appropriate safety measures to protect women, babies and themselves. Staff should undertake and document appropriate risk assessments for women and their babies and take timely action, including escalation, when required.

NHS boards should have robust processes in place to support innovation and changes in maternity care practice. This includes the safe and appropriate adoption of new technologies for appointments and home monitoring, participation in local and national quality improvement initiatives and engagement in research activities that contribute to service development.

NHS boards should take appropriate measures to promote environmental sustainability. This includes monitoring Entonox® use, reducing reliance on single use items and offering home monitoring and video or telephone appointments where clinically appropriate.

Criteria

4.1

NHS boards ensure women and their babies receive maternity care that is accessible, appropriate to their care needs and provided as close to home as possible.

4.2

Where women have to travel to receive their maternity care, NHS boards:

  • have clear, accessible and fair policies for reimbursement of reasonable travel costs in line with national guidance
  • have clear accommodation policies for women and their babies (and, where appropriate, their care partners)
  • provide women with tailored information about what costs are covered
  • collaborate with community partners to address transport barriers.
4.3

NHS boards have clear pathways to ensure safe and timely transfer of women and their babies between different care settings and/or providers. These pathways cover:

  • transfer between providers, including the Scottish Ambulance Service
  • care delivered out with the board of residence, such as arrangements for island boards or access to regional specialist centres
  • transfer between facilities and services, for example, midwifery to health visiting
  • access to high-dependency and critical care, ensuring women and their babies can be escalated promptly, when required.

These pathways ensure equitable care for women and their babies.

4.4

When care is transferred or shared between teams, services or providers, NHS boards ensure safe and effective care ensuring all communication and care plans:

  • are accurate and shared contemporaneously
  • are robust and effective
  • are clear and easily accessible to all care providers and to the woman
  • clearly set out how and where care can be accessed in urgent or emergency situations.
4.5

NHS boards can demonstrate that reciprocal arrangements and processes are in place to ensure seamless and coordinated care of women and their babies.

4.6

NHS boards ensure that facilities for maternity care, including those used for examinations, screening and assessments, are designed to:

  • maximise privacy, dignity and safety
  • reflect the needs of their local population and be culturally-appropriate
  • provide person-centred and trauma-informed care
  • support women with additional or complex needs, including those with physical, visual or hearing impairments/needs
  • provide a supportive, calming and therapeutic environment for birthing women, including features such as adjustable lighting, comfort items and music
  • promote a range of birthing options and facilitate maternal mobility during labour
  • enable family-centred maternity care
  • provide separate accommodation for women who have experienced pregnancy or baby loss.
4.7

NHS boards have systems and processes in place to ensure appointments are equitable and person centred. This includes:

  • providing in-person, remote (telephone or online) or digital (such as NHS Near Me) appointments, where appropriate or requested
  • coordinated appointments to reduce unnecessary travel and improve continuity
  • offering extended appointments to women with additional requirements, including people with communication needs, learning disabilities and complex social needs
  • providing additional support during appointments, including the option for a care partner to attend
  • using digital technologies to support remote patient monitoring when clinically appropriate.

Where care is delivered remotely or using digital tools, the principles of providing an inclusive, safe and trauma-informed environment still apply..

4.8

NHS boards monitor and review missed antenatal and postnatal visits or appointments to:

  • understand the impact of health inequalities on attendance and access to services
  • identify gaps, issues or trends
  • develop improvement or action plans
  • identify women who may require proactive follow-up and support to re-engage with maternity services.
4.9

NHS boards ensure timely access to a fully-equipped and staffed obstetric operating theatre located within, or adjacent to, the labour ward. Robust contingency plans are in place to manage situations where simultaneous obstetric emergencies require simultaneous theatre access.

4.10

NHS boards have effective cooperation agreements and collaborative working arrangements with other NHS providers and partners, including third sector organisations, to support the planning and delivery of services.

4.11

NHS boards ensure that all facilities, equipment and peripherals used in the delivery of maternity care are well maintained and comply with national or regulatory equipment specification and infection prevention control requirements.

4.12

NHS boards develop and implement policies to minimise the environmental impact of delivering maternity care in line with national sustainability policy and guidance.

What does this standard mean for...

What does the standard mean for women and their babies?

  • Your maternity care will be as accessible and as close to your home as possible.
  • You will be offered appointments that meet your needs.
  • If you would like someone to attend the appointment with you or if you need additional support, staff will support you to arrange this.
  • If you have to travel to access services, you will be able to claim reasonable expenses.
  • If you need overnight accommodation, this will be discussed with you.
  • Maternity services will be welcoming, respectful and supportive.
  • If you need to receive any of your maternity care from another NHS board, this will be coordinated for you and your care plan will be followed.
  • If you have your baby in hospital, the birth environment (labour ward or maternity unit) will include specially designed spaces that will help you to feel comfortable and relaxed, including birthing pools, where available. You will be able to have your own music.
  • NHS facilities will be safe, clean and well maintained.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting, are enabled to:

  • offer pathways of care to support transition and transfer of care
  • promote active birth and mobility
  • provide care in a relaxed and welcoming environment
  • offer appointments that are responsive to the needs of women
  • access facilities and provide equipment that is suitable, high quality and well maintained
  • implement practices that reduce the environmental impact of Entonox® and other medical supplies.

What does the standard mean for the NHS board?

NHS boards:

  • deliver maternity care that is accessible and as close to home as possible
  • have clear and accessible policies for reimbursement of travel or other expenses in line with national guidance
  • work with other NHS providers and partners to ensure equitable and accessible access to maternity care
  • minimise unnecessary delays in care when a woman has to travel or be transferred between care settings or providers
  • ensure staff are supported to be responsive to women’s additional care needs, for example offering flexible appointment times to accommodate translation and interpreter services
  • review missed appointments and support the re-engagement of women with services
  • provide high-quality equipment and healthcare facilities that are decontaminated in line with national protocols and subject to regular environmental monitoring
  • have planned maintenance and replacement schedules, with mechanisms for routine checks and testing of equipment
  • promote environmental sustainability.

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

4.1

Evidence of supporting people in local, home or community-based services.

4.2

 Reasonable travel and expense policies that align with national guidance.

4.3

Pathways, guidance and protocols outlining transfer of care between healthcare settings, facilities and providers, including Scottish Ambulance Service.

4.4

Robust communication plans and handovers that are shared contemporaneously.

4.5

Documentation such as service-level agreements describing reciprocal maternity care arrangements.

4.6

Provision of facilities that enable person-centred and trauma-informed care including active births and mobility.

4.7

Use of text reminders for appointments, online consultations and other technology to widen access to services.

4.8

Evidence of collection and review of data on missed visits and appointments with action plans.

4.9

Contingency plans for emergency access to obstetric operating theatres.

4.10

Formal cooperation agreements, memorandum of understanding or service-level agreements with neighbouring NHS boards, Integration Joint Boards, local authorities and third sector partners.

4.11

Environmental monitoring documentation to demonstrate compliance with decontamination protocols and the National IPC manual.

4.12

Regular audits and improvement plans for environmental sustainability, including use of Entonox® and single use disposables.

 

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.