Martha’s Rule is coming to maternity care. And the fact we need it says a lot.

There’s something happening in maternity care right now that I want every pregnant woman to know about.

It’s called Martha’s Rule.

Not because I want you spending your pregnancy worrying about everything that could possibly go wrong, or because I think you need yet another bloody thing to research, save, screenshot and add to the endless list of things pregnant women are apparently supposed to know.

But because if you are ever sitting in a hospital bed thinking something is wrong with me, or your partner is standing beside you saying she is NOT okay, I want you both to know what you can do next.

Because we have heard this sentence far too many fucking times after something awful has happened.

“I told them something was wrong.”

And nobody listened.

First, who was Martha?

Martha Mills was 13 years old when she died in 2021 after developing sepsis following an injury to her pancreas.

Her parents repeatedly raised concerns that she was getting worse. They knew their daughter, they were right there watching the changes happen in front of them and they tried to tell the people caring for her that something wasn’t right.

Their concerns weren’t responded to appropriately.

A coroner later concluded that Martha would probably have survived if she’d been transferred to intensive care earlier. That’s incredibly hard to read. Because her parents were there.

They were watching.

They were speaking.

They just weren’t being heard.

Martha’s Rule exists because they should have been.

So what actually is Martha’s Rule?

Basically, it’s another door.

If you’re in hospital and you think you’re becoming more unwell, or somebody who knows and loves you can see you’re deteriorating, you raise that concern with the team caring for you.

But what happens when you’ve done that and you’re still worried?

What happens when you’ve said it once, twice, three times and you’re getting that horrible feeling that nobody quite understands what you’re trying to tell them?

Where Martha’s Rule is operating, you can request an urgent review from a different clinical team.

You don’t need to diagnose yourself first. You don’t need to understand every number on the monitor, know the medical terminology or have spent six hours on Google convincing yourself that you have enough evidence to justify bothering somebody.

You can simply know:

Something has changed. And I’m worried.

That is enough to raise a concern.

And now it’s coming to maternity care.

In June 2026, following Donna Ockenden’s final review into maternity and neonatal services at Nottingham University Hospitals, the government announced that Martha’s Rule would be extended across maternity and neonatal services in England.

And if you’ve followed maternity news for any length of time, you probably won’t be shocked by some of what that review found.

Women not being listened to. Concerns being dismissed. Deterioration not always being recognised quickly enough. Families raising alarms. Staff themselves describing difficulties speaking up.

We’ve heard versions of this before.

Different hospital. Different investigation. Different family.

Same fucking sentences.

I knew something wasn’t right.

I tried to tell them.

Nobody listened.

And that is exactly why I think pregnant women and their partners need to know Martha’s Rule exists.

What could this actually look like in maternity care?

Imagine you’ve just given birth.

You’re becoming increasingly unwell and you can’t necessarily explain exactly what’s happening, you just know you don’t feel right. Maybe you’re dizzy, confused, in pain, incredibly weak or you simply feel completely different from how you did an hour ago.

You’ve said something. Someone checks you.

You’re still getting worse. Your partner is watching all of this and saying, “She isn’t normally like this.”

Maybe somebody tells you your observations were fine earlier. Maybe someone says they’ll come back. Maybe everyone is incredibly busy and you can see that, so you start wondering whether you’re making too much of it.

Don’t shrink your concern because the ward is busy.

Or maybe it’s your baby you’re worried about. You’ve raised it already but that feeling isn’t going away and you don’t feel like the urgency you’re experiencing is being understood.

Where Martha’s Rule is available within that service, it gives you another escalation route and another clinical team can review what’s happening.

Another set of eyes.

Sometimes that’s exactly what’s needed.

But I need to make something really clear.

Martha’s Rule isn’t a magic phrase you shout whenever you disagree with your consultant.

It’s not a replacement for informed consent, and it isn’t the mechanism you use because you’re declining an induction, choosing a home birth outside guidelines, planning a VBAC or disagreeing with a proposed plan of care.

Martha’s Rule is about deterioration.

You believe you or your baby is becoming more unwell, you’ve raised that concern and you don’t believe it’s being adequately responded to.

The distinction matters.

Because I also don’t want a woman being told, “That’s not what Martha’s Rule is for,” and somehow coming away believing that means she has no right to question, decline or make a different decision about her care.

You absolutely fucking do.

They’re just different conversations, different rights and sometimes different escalation routes.

Knowing which door to knock on matters.

And don’t assume your hospital already has it.

This is really important.

Some of the headlines make it sound as though somebody flicked a massive Martha’s Rule switch in June and suddenly every maternity service in England had it.

That’s not what happened.

The government has committed to extending Martha’s Rule across maternity and neonatal services, but implementation is still being expanded, which means if you’re pregnant right now you should actually ask your own maternity service what is available locally.

Ask them:

“Is Martha’s Rule currently available within your maternity service and, if it is, how do I access it?”

If there’s a number, save it. Get your partner to save it too. Hopefully it sits there throughout your entire pregnancy, birth and postnatal period and you never touch the bloody thing.

Brilliant.

I’d still rather you have it.

Because trying to find an escalation number while you’re frightened, exhausted and desperately trying to convince somebody that something isn’t right is not the moment you want to start Googling.

Birth partners, this bit is for you.

We put an enormous amount of responsibility on women to advocate for themselves during birth and sometimes I think we need to be a bit more fucking realistic about what we’re actually asking them to do.

Yes, she might normally be the woman who walks into a room and takes absolutely no shit.

But now she’s contracting. She’s exhausted. She hasn’t eaten properly. Maybe she hasn’t slept for 30 hours, she’s vomiting, she’s frightened, she’s had medication and she’s trying to process new information while several people are talking around her.

And apparently she’s also supposed to transform into a barrister and calmly present her case.

Come on.

Sometimes you need to speak. You know her.

You know how she normally talks, looks and behaves. You might recognise that she’s suddenly confused, unusually quiet or simply not herself before somebody who met her at the beginning of their shift understands just how different she is.

So if you’re standing beside her thinking:

Something is wrong with her. This isn’t normal. Say it.

And if you’ve said it and you still don’t feel heard, say it again.

Now can we talk about the fucking elephant in the room?

I welcome Martha’s Rule.

Of course I do.

If another escalation route means one woman is reviewed earlier, one deteriorating baby gets another pair of eyes on them, one partner’s concern is taken seriously or one family doesn’t experience something that could have been prevented, then thank fuck that route exists.

But surely we’re allowed to ask why we needed to create it in the first place.

Because when you strip away all the policy language, implementation plans and clinical terminology, Martha’s Rule essentially acknowledges something families have been screaming about for years:

Sometimes patients know something is wrong and they aren’t listened to.

Women have been telling us this about maternity care for YEARS.

I knew something wasn’t right. They said I was anxious. My partner kept telling them. I didn’t want to make a fuss. They told me it was normal. I thought they knew best.

Then another investigation happens.

Another review.

Another set of recommendations.

Another promise that lessons will be learned.

And somewhere there is another family wishing somebody had just fucking listened the first time.

That’s the part I can’t ignore.

So yes, Martha’s Rule matters and I am genuinely glad it’s being brought into maternity care.

But I’ll be even happier when the culture changes enough that women rarely need to use it.

If you’re pregnant right now, here’s what I want you to take from this.

I don’t want you frightened of maternity care.

I don’t want you assuming nobody will listen to you, and I definitely don’t want you spending the rest of your pregnancy preparing yourself for a fight that may never happen.

I want you informed.

Know your maternity triage number. Know who you contact when something doesn’t feel right.

Ask whether Martha’s Rule is currently available in your maternity service and, if it is, save the details and make sure whoever is supporting you knows them too.

Then hopefully you never need them.

But please stop believing that you need to know what is wrong before you’re entitled to say something feels wrong.

You know your body.

You know your baby.

Your partner knows you.

Clinical expertise matters. Observations matter. Tests matter. Experience matters.

And so does the woman sitting in the fucking bed saying:

“This isn’t right.”

Martha’s Rule doesn’t mean you’ll always be medically correct. It means your concern shouldn’t simply disappear because somebody else isn’t concerned yet.

You are not a passive passenger in your maternity care.

Your voice is information.

Use it.