Martha’s Rule explained: What expectant parents need to know about maternity care

Pregnancy involves many conversations. From your first maternity appointments to decisions about scans, tests and birth preferences, being able to ask questions and understand the information you are given can make a meaningful difference to your experience.

For many expectant parents, good maternity care is built on trust, communication and feeling listened to. These principles are closely aligned with the thinking behind Martha’s Rule, a patient safety initiative introduced across NHS acute hospitals in England.

However, it is important to understand exactly what Martha’s Rule does and does not mean for maternity care and private ultrasound appointments.

Martha’s Rule is primarily an NHS patient safety initiative designed to help identify deterioration in patients in hospital. It gives patients, families, carers and staff a route to raise concerns and where appropriate request a rapid review by another clinical team.

The wider message is also relevant to pregnancy: your concerns matter and asking questions should be part of an open conversation about your care.

What is Martha’s Rule?

Martha’s Rule is an NHS patient safety initiative developed following the death of Martha Mills. Martha’s family had raised concerns about her deteriorating condition and her case highlighted the importance of listening to patients and families when they believe someone’s condition may be getting worse.

The initiative has three core components:

1. Patients are asked regularly how they are feeling and whether they believe their condition is improving or worsening with this information considered as part of their care.
2. Staff can request a review from another team when they are concerned about deterioration and feel their concerns are not being responded to.
3. Patients, families and carers have access to an escalation route to request a rapid review if they remain concerned that a patient’s condition is getting worse.

It is also important to distinguish Martha’s Rule from a general right to request a second opinion. NHS England specifically states that Martha’s Rule is not the same as a second opinion. Its focus is on concerns about possible deterioration and ensuring those concerns can be escalated appropriately.

Does Martha’s Rule apply to maternity care?

Martha’s Rule was introduced across NHS acute hospitals in England, with its implementation focused initially on inpatient care. NHS England has also been testing how the principles can be applied in maternity, neonatal and emergency settings.

Implementation is continuing, and the arrangements available to you will depend on the NHS service providing your care. If you are receiving hospital care and are concerned that your condition or that of someone you are supporting is getting worse, you can ask the clinical team how concerns about deterioration can be escalated and whether Martha’s Rule is available within that service.

There is no single national telephone number dedicated to Martha’s Rule. Individual hospitals have their own arrangements for implementing the initiative.

What does Martha’s Rule mean during pregnancy?

For expectant parents, the principles behind Martha’s Rule are closely linked with one of the foundations of good maternity care: listening and communication.

You may see a range of healthcare professionals during your pregnancy, including midwives, obstetricians, GPs and sonographers. Each professional brings different knowledge and expertise to your care.

You should feel able to ask questions when you do not understand something.

For example:

• “Can you explain what you have found?”
• “What does this result mean?”
• “What happens next?”
• “Are there different options available?”
• “Why has this test or appointment been recommended?”
• “Who should I contact if I become concerned?”

Asking questions does not mean you are challenging someone’s expertise. It is a way of making sure you understand the information being provided.

Good care involves both sides listening to one another.

Why communication matters during pregnancy scans

Pregnancy can involve a considerable amount of information, particularly if you are having additional appointments or investigations.

You may receive advice from different members of your maternity team and it is reasonable to ask how information from one appointment relates to another.

Good communication can help you understand:

• what has been assessed;
• what the findings mean;
• whether anything requires further assessment;
• what your options are;
• who is responsible for your ongoing care; and
• what you should do if your circumstances change.

Being involved in your care does not mean that you are expected to make medical decisions without professional guidance.

Instead, it means having enough information to take part in conversations about your care and to communicate concerns when you have them.

What about private pregnancy scans?

Private ultrasound scans are different from NHS hospital maternity care. A private scan can provide information about the pregnancy at the time of the examination, depending on the type of scan being performed, the stage of pregnancy and the purpose of the appointment.

A private scan is not a replacement for your NHS maternity team, midwife, obstetrician, GP or urgent medical assessment. If you have an urgent concern about your health or your pregnancy, you should contact your NHS maternity or healthcare service.

What can a pregnancy scan tell you?

The information available from an ultrasound depends on the type of scan and what is being assessed.

A scan may provide useful information about aspects of pregnancy and fetal development, but no ultrasound examination can provide a guarantee that everything is normal or identify every possible condition.

This is why responsible communication is important.

Before attending a scan you may wish to ask

• What is this scan designed to assess?
• What will the sonographer be looking at?
• What are the limitations of the examination?
• Will I be told about the findings during the appointment?
• What happens if something unexpected is seen?
• Who should I contact if I have concerns afterwards?

Understanding the purpose and limitations of an examination can help you have realistic expectations about what the appointment can provide.

Can I raise concerns about my maternity care?

Yes. You can and should communicate concerns about your care. The appropriate route depends on the nature and urgency of the concern.

If you are worried about symptoms, feel unwell or believe there has been a change in your pregnancy that needs assessment, contact your maternity team or appropriate healthcare service. Do not wait for a private scan appointment if you need medical assessment.

If you are an inpatient and are concerned that your condition is deteriorating, ask your hospital team about the process for escalating concerns and whether Martha’s Rule is available.

If your concern is about the service you have received you should review the complaints or feedback process.

Martha’s Rule is primarily concerned with patient safety and possible deterioration. A complaint is a way of raising concerns about the service or care you have received.

How can expectant parents feel more involved in their maternity care?

Feeling involved does not mean becoming an expert in pregnancy or knowing every medical term. Small steps can make conversations with your healthcare team easier.

Write down questions before appointments

Pregnancy can involve a lot of information. Keeping questions in your phone or in your pregnancy notes can help you remember what you would like to discuss.

Ask for explanations in plain language

If a healthcare professional uses terminology you do not understand, ask them to explain it in another way. There is nothing wrong with saying
“Could you explain what that means in everyday language?”

Understand the purpose of your appointment and scans

Ask what an examination is intended to assess and what its limitations are. This can help you understand what information you can reasonably expect from the appointment.

Bring someone with you when appropriate

Many expectant parents find it helpful to have a partner, family member or trusted person attend appointments where possible. A second person can help remember information and provide support.

Ask what happens next

Ask when your next scheduled appointment is likely to be.
If something unexpected is identified during an appointment, ask what the next step is and which health care professional or service should be contacted.

Share concerns early

If you notice a change in your symptoms or are worried about your pregnancy, tell your maternity team.
Remember that a private ultrasound scan is not the right place to investigate a concern. Your NHS maternity team is your primary service, Yorkshire Baby Scan services is to complement your NHS service.

Your concerns are part of the conversation.

Pregnancy involves many decisions, from routine appointments to choices about your birth preferences. Having clear information allows you to understand what is happening and take part in those discussions.

Final thoughts

Martha’s Rule is an important development in NHS patient safety. It is primarily designed to help identify and escalate concerns about possible deterioration in hospital patients. Its implementation across maternity services is developing, so the precise process available to an expectant parent will depend on the service providing their care.

Martha’s Rule is a reminder that listening and communication is a vital part of healthcare. For expectant parents, it highlights the value of asking questions and being involved in conversations about your pregnancy care.

You do not need to have all the answers before attending appointments. Your maternity team is there to guide you, explain what is happening and support you through the different stages of pregnancy. You should feel able to ask questions, request explanations and communicate concerns about your care.

Most importantly, if you are worried about symptoms or think something may be wrong during pregnancy, contact your maternity or healthcare team for appropriate medical advice. A private scan should never be used as a substitute for urgent or routine maternity care.

Asking questions is not about being difficult. It is about understanding your care, communicating openly and knowing what to do next.