Introduction

A legal obligation for birth notifications has existed in England since 1907. The purpose of birth notification is to ensure that relevant health bodies can offer appropriate support to women and babies. This requirement remains in place under Section 269 of the NHS Act 2006, as amended by the Health and Social Care Act 2022.

For births that occur within an NHS trust and/or with private health providers – whether in a hospital setting or at home with the support of a registered midwife – birth notifications are processed automatically through the Maternity Information System.

This guidance specifically outlines the legal requirement and administrative process for birth notifications following an unassisted birth (often known as “free birthing”). An unassisted birth is defined as one where a woman decides to give birth without the support of a registered healthcare professional, whether NHS or privately funded. This does not include situations where a baby is born before arrival while the woman is attempting to access medical assistance. In this context, unassisted birth is a conscious decision to opt-out of antenatal and/or intrapartum care.

Where women have accessed antenatal but not intrapartum care, this guidance sets out how they can continue to engage with healthcare services, should they so wish, following an unassisted birth, and receive postnatal care. It also outlines how healthcare professionals can support families in making the required birth notification in these instances.

This guidance is designed to assist women, families, healthcare professionals, Child Health Information Services (CHIS), and other relevant bodies in understanding the notification process to NHS England and ensuring compliance with Section 269 of the NHS Act 2006. This guidance is for notification to NHS England. Integrated care Bboards and local authorities (in exercise of their public health functions) can set up alternative notification arrangements locally if they wish.

This process and guidance are intended to be non-judgmental in why women choose to have unassisted births, recognising the diverse and often complex reasons why women may choose to have an unassisted birth.

In developing this guidance, we have worked collaboratively with individuals who have lived experience of unassisted birth, as well as healthcare professionals and other services who have supported them. Our aim is to ensure that the process is clear, accessible, and responsive to the needs of those it serves.

This guidance provides a systematic overview of the steps involved, ensuring clarity for women, families, healthcare professionals, CHIS, and other relevant bodies. It also clarifies responsibilities, postnatal care and infant health options, NHS number allocation, and where relevant, safeguarding considerations.

This guidance aims to ensure clarity around the distinction between birth notification and birth registration, whilst acknowledging and supporting the interoperability of the two processes and supporting individuals in meeting legal requirements and accessing necessary health services.

Throughout this guidance, we use the term nominated CHIS. For the purposes of this process, the nominated CHIS refers to NHS South, Central and West Commissioning Support Unit (NHS SCW).

The difference between birth notification and birth registration

Birth notification is distinct from birth registration. Birth registration is the process of officially recording a birth and obtaining a Birth Certificate. More information on birth registration is available at GOV.UK.

A birth notification is the administrative process of informing health services and the local authority’s health functions that a birth has occurred. This ensures that each child has the opportunity to be known to, and registered, in the healthcare system, and has access to services such as immunisations, newborn screening, and health visitor appointments.

It is important to note that a birth notification is a separate legal requirement to registering a birth. A birth can still be registered if a birth notification fails to take place.

NHS England’s birth notification process is a self-declaration that an unassisted live birth took place, along with details of any other person present at the birth who can verify key information. Details from the self-declaration can be presented during birth registration to provide additional evidence to the Registrar of Births and Deaths. It is up to the discretion of the Registrar of Births and Deaths in the local area to accept the self-declaration as evidence to satisfy themselves where and when the birth took place.

Making a birth notification

Who must make a birth notification

Section 269 of the National Health Service Act 2006 states there is a statutory obligation for specific individuals to notify the relevant bodies (e.g., NHS England, local authority (in exercise of its public health functions), integrated care board) of a birth.

A person does not have to give notification if they have reasonable grounds to believe notification has been given by some other person.

For unassisted births, those who (provided they are competent and capable of fulfilling these responsibilities) must make a birth notification are:

• any individual person present, during or within six hours of the birth
• the child’s father, if at the time of the birth they are residing on the premises where the birth takes place (regardless of their attendance at or after the birth)

As set out in section 269 of the National Health Service Act 2006.

Throughout this guidance the person making the notification will be referred to as ‘notifier’.

Mothers and birth notification

NHS England will accept a birth notification from the mother, however, under Section 269 of the National Health Service Act 2006, mothers do not have a legal obligation to notify their own birth.

If a mother does give notification within 36 hours, other people do not have to.

By when must the birth notification take place and to who

Notification must be submitted within 36 hours of the birth to one of the relevant bodies, these include: NHS England, the integrated care board, or the local authority (in exercise of its health functions). The notifier can choose which relevant body to notify, this guidance relates to notification to NHS England and other relevant bodies can devise their own local systems for notifications.

How to submit a birth notification to NHS England

If a woman does not wish to see a midwife or healthcare professional, regardless of their geographical location, they should contact the nominated CHIS to submit a birth notification within 36 hours of an unassisted live birth by emailing scwcsu.chis.unassistedbirths@nhs.net

As part of the notification process, the following information is required by the nominated CHIS to produce a “digital postcard” confirming the birth notification:

• baby’s full name, or “baby [surname]” if a name has not yet been decided
• date and time of birth
• full address, and postcode, where the birth occurred
• full address, and postcode, for the woman’s residence (if different to above)
• name of the parent(s)
• sex of the baby
• name of any other person present within 6 hours of Birth:
• valid email

An unassisted birth notification cannot be made without this information. The information received is a self-declaration; where a person is required to provide the notification providing inaccurate information or failing to give notice of a birth is liable on summary conviction to a fine not exceeding level 1 on the standard scale, unless they satisfy the court that they believed, and had reasonable grounds for believing, that notice had been duly given by some other person.

Registered healthcare professionals who are contacted by an individual wishing to notify an unassisted birth (where the woman does not wish her and baby to be seen by a healthcare professional) should direct the individual to NHS SCW, as above.

Local CHIS who are contacted by an individual wishing to notify an unassisted birth should direct them to NHS SCW. Local CHIS should not attempt to process these notifications themselves but should ensure that individuals are correctly signposted to the appropriate health services and NHS SCW.

The digital postcard

After the submission of a birth notification, the email address provided by the notifier will receive a self-declaration document – referred to as a digital postcard – from NHS SCW.

This digital postcard serves as confirmation of the birth notification. Women and families should retain a copy of their digital postcard for their records.

A digital postcard does not automatically generate an NHS number. An NHS number is only assigned once a registered healthcare professional has seen the baby, and parental consent has been given. If consent is provided, a healthcare professional will arrange a newborn check with the woman present, after which the baby will receive an NHS number.

Postnatal care and infant health services via NHS

As well as the digital postcard, women and notifiers submitting a birth notification will also receive information on additional health services that the women and baby are entitled to:

The NHS recommends all babies receive the following:

• Vitamin K supplement at birth
• Newborn and Infant Physical Screening Examination (NIPE)
• Newborn hearing check
• Newborn blood spot
• Access to postnatal maternity care up to 28 days after the birth, if needed
• Access to the Healthy Child Programme via local health visiting services
• Access to the 6–8-week GP postnatal consultation and immunisations for babies

As service pathways vary by location, women and families are encouraged to check their local authority’s and NHS trust’s website for details on accessing these services or contact their GP.

In line with NHS England’s policy, NHS SCW will share the self-declaration with the local CHIS, within 24 hours of the notification, based on the postcode provided on the digital postcard.

Information will not be routinely shared with the other relevant bodies (ICBs and local authorities). However, where information sharing agreements are in place it may be shared by the nominated CHIS with ICBs and local authorities to support the facilitation of local care pathways in delivering health services. ICBs and local authorities must establish information-sharing agreements with the nominated CHIS and NHS England, or have existing arrangements in place with their local CHIS provider.

These local health services may reach out to women and families with local service offers and local health services are encouraged to do so. This proactive engagement to offer support will depend on locally or regionally agreed pathways. However, if families wish to access support, they should contact their local maternity unit, GP, or local health visiting services, and, if urgent 111 or an emergency, through 999.

Adverse outcomes during or after an unassisted birth

Experiencing complications during or after an unassisted birth can be distressing. If the woman or baby shows signs of serious illness, distress, or deterioration, it is essential to seek urgent medical attention.

If a baby is born with no signs of life, this is an incredibly difficult and emotional situation. Families should seek urgent medical support by calling 999, who will then provide the immediate support as well as ensuring that health care professionals can offer physical and emotional care.

Notifications, in the case of a stillbirth, should not be made through the nominated CHIS as this is an administrative process. Notifications submitted through this process will not be processed or accepted. By submitting a birth notification via this process, you are confirming that the birth resulted in a live birth.

In the event that the baby is stillborn (after 24 weeks) and shows no sign of life, which has been confirmed by a health professional, a birth notification is still required under Section 269 of the NHS Act 2006, as amended by the Health and Social Care Act 2022. This notification will typically be submitted via the local maternity information system. The healthcare professional will provide guidance and support throughout this distressing time.

Roles and responsibilities

Women, families and birth companions

• notify the birth within 36 hours
• can access postnatal care if they choose, including checks for their baby
• must complete birth registration separately with the Registrar of Birth and Deaths within 42 days.
• can request an NHS number for the baby through a registered healthcare professional, following consent for both the woman and baby to be reviewed by a healthcare professional
• must provide accurate and complete information for the birth notification process

Registered healthcare professionals

• provide information to woman about the birth notification process
• assist women with the NHS number allocation process when they choose to engage with healthcare services
• ensure documentation is accurate to facilitate NHS number allocation
• encourage postnatal engagement and newborn health checks where appropriate
• follow safeguarding protocols if there are concerns regarding the welfare of the woman or child. A safeguarding referral should not be made just because a woman decides to have an unassisted birth or declines maternity care
• communicate with CHIS regarding birth notifications and healthcare updates

Local Child Health Information Services (CHIS)

• ensure birth records are updated following notification and postnatal engagement
• monitor and facilitate postnatal care by tracking newborn health checks
• ensure safeguarding concerns are escalated appropriately if necessary
• liaise with the nominated CHIS to update when an NHS number has been generated to maintain accurate birth records

Nominated Child Health Information Service (CHIS)

• receive and process birth notifications for unassisted births in England
• lssue self-declaration documents (digital postcards) to individuals confirming notification
• manage data reconciliation to ensure accurate NHS record updates
• notify the local CHIS by the next working day of creating the digital postcard, and coordinate with local CHIS to track local engagement with healthcare professionals
• if ICBs and /or local authorities have an information-sharing agreement in place, the nominated CHIS will notify them within one working day of creating the digital postcard

Useful resources

• Register a birth: Overview – GOV.UK
• Register a stillbirth – GOV.UK
• Saving babies’ lives | Tommy’s | The pregnancy and baby charity
• Sands | Saving babies’ lives. Supporting bereaved families.

Appendix A: additional information

For women and families

A separate factsheet document for women and families has been created alongside this guidance document, which is available alongside this guidance on the NHS website.

For registered healthcare professionals

Registered healthcare professionals play a vital role in supporting women throughout pregnancy and the postnatal period. While women have the right to opt out of healthcare at any stage, healthcare professionals should ensure individuals receive clear information on accessing antenatal and postnatal care, as well as the Healthy Child Programme, which includes guidance on newborn screening and immunisation for babies.

Women may choose to opt in and out of care at different stages, healthcare professionals should provide timely, relevant, and comprehensive information to support informed decision-making for both the woman and her family. For instance, a woman may receive antenatal care but later choose an unassisted birth. In such cases, the healthcare professional should ensure the family understands how to access healthcare for both woman and baby, the birth notification process, and the steps to obtain an NHS number for the baby.

If, following an unassisted birth, a parent consents to a visit from an healthcare professional, and the healthcare professional provides care for the woman and baby they must document the contact in the appropriate system to ensure seamless communication and continuity of care.

If safeguarding concerns arise, the registered healthcare professional must follow local safeguarding policies and procedures to protect the well-being of both woman and child.

If a registered midwife provides care following an unassisted birth, when the woman was known to maternity services during the antenatal period, the midwife may complete the birth notification via the Maternity Information System (MIS). Ideally, they should see the woman within 6 hours of the birth. This allows for the generation of an NHS number for the baby and ensures the intrapartum care is recorded as an unassisted birth within both the woman’s and baby’s healthcare records.

If the woman was not previously known to maternity services, or if the midwife is unable to see her within 6 hours, the midwife should direct the woman to make the birth notification via the nominated CHIS. In these cases, the midwife should also arrange for a postnatal follow-up within 36 hours or sooner if clinically indicated.

Where maternity services are contacted following an unassisted birth, and the woman requests support, this should be prioritised by services and all reasonable efforts should be made to visit the woman and baby within 36 hours as per the NICE Standards on Postnatal Care for follow up visits postnatally.

If any other registered healthcare professional (e.g. GP, health visitor) provides care to the woman and/or baby within 6 hours of an unassisted birth, they should follow their usual procedures for clinical record-keeping and initiating the process for NHS number allocation.

For Local Child Health Information Services

Although birth notifications to NHS England for unassisted births are now managed centrally, local CHIS continue to play an important role in ensuring that newborns receive appropriate postnatal care. If a registered healthcare professional later sees the baby – for example, during a newborn examination or a health visitor review – the local CHIS should ensure that this information is recorded, and the nominated CHIS should be notified.

Additionally, safeguarding responsibilities remain unchanged. If any concerns arise regarding the wellbeing of a child, the local CHIS must escalate these concerns to the appropriate safeguarding teams in line with established protocols. Local CHIS should also provide guidance to parents on how to access postnatal care, including information on newborn screening and immunisation services.

In cases where a local CHIS is notified that an NHS number has been created for a baby born via unassisted birth, it is essential that they inform the nominated CHIS as soon as possible. This allows the nominated CHIS to reconcile records and ensure that the birth notification entry is updated accurately. Timely communication between local CHISs and the nominated CHIS is critical in maintaining data integrity, avoiding duplication, and ensuring that all newborns are properly recorded within NHS systems.

If there are any discrepancies in birth notification records, or if concerns arise about the accuracy of the information received, local CHIS should liaise with the nominated CHIS to resolve these issues. In cases where safeguarding concerns are identified, the local CHIS should continue to follow standard escalation procedures and ensure that appropriate local authorities are informed.

For the Nominated Child Health Information Services

Logging and secure record management

The nominated CHIS must develop and maintain a secure system for receiving and logging birth notifications. Unassisted birth notifications should be managed separately from routine birth notifications to maintain clarity and data integrity. Notably, NHS numbers should not be automatically generated upon notification.

Data reconciliation and integration

To ensure accuracy, the CHIS must implement a process for reconciling and integrating birth records if an NHS number is later generated following healthcare engagement. An auditable trail of all received notifications and their outcomes should be maintained for transparency and accountability.

Data reporting and communication

The CHIS must document:

• the total number of notifications received
• the number of babies who later receive an NHS number
• parental feedback and satisfaction levels

Anonymised statistical data should be reported to NHS England on a quarterly basis.

Identifying data from the nominated CHIS will not routinely be shared with NHS England, however, NHS England holds the right to request data based on operational needs.

Communication with other CHIS

The nominated CHIS must establish protocols to ensure that notifications are shared with the appropriate local CHIS based on the home address of the woman.

Information will not be routinely shared with other relevant bodies, ICBs and local authorities. However, where information sharing agreement are in place it can be shared by the nominated CHIS with the other relevant bodies (ICBs and local authorities) to support the facilitation of local care pathways in delivering health services. Other relevant bodies must establish information-sharing agreements with the nominated CHIS and NHS England or have existing arrangements in place with their local CHIS provider.

Safeguarding protocols

Safeguarding procedures must be clearly defined and documented. If any concerns arise during the notification process, all CHIS must immediately escalate the case to the appropriate safeguarding teams through usual procedures.

Compliance and governance

The CHIS must operate in full compliance with statutory requirements under the NHS Act 2006. Best practices in GDPR and data protection must be followed when handling birth notifications to maintain confidentiality and security. The nominated CHIS will also participate in interim evaluations to assess the effectiveness of the process and identify areas for improvement. 

Publication reference: PRN02008i