The Maternity and Newborn Safety Investigations (MNSI) programme is designed to improve the quality and safety of maternity care by understanding what led to a serious incident during childbirth. After speaking with many families, I understand the investigation process – especially after a difficult or traumatic birth – can feel overwhelming and emotionally draining. My hope is this guide helps families feel more informed and supported about what to expect.
What is MNSI?
MNSI is a national programme focused on learning from serious incidents in maternity and newborn care within the NHS in England. It applies to families whose baby was born after 1 April 2017 and where there are concerns that a baby may have suffered a brain injury during delivery.
When a case meets certain criteria, the NHS Trust will refer it to MNSI. An independent investigation is then carried out to better understand what happened and, importantly, how care can be improved for other families in the future.
When does MNSI investigate?
MNSI investigates specific, serious outcomes involving term babies (born at or after 37 weeks) following labour. These include:
- Intrapartum stillbirth – where a baby who was thought to be alive at the start of labour is born with no signs of life.
- Early neonatal death – where a baby passes away within the first 0–6 days of life.
- Potential severe brain injury – explained further below.
MNSI also investigates maternal deaths.
What is meant by a potential severe brain injury?
MNSI may investigate cases where a baby has experienced a possible severe brain injury. This can include situations where a baby has received therapeutic cooling treatment or has been diagnosed with moderate to severe encephalopathy, alongside symptoms such as:
- Low muscle tone (hypotonia)
- Abnormal reflexes
- A weak or absent suck
- Clinical seizures
How does the investigation process work?
Every investigation is slightly different, but there is a general process you can expect:
- The NHS Trust refers the case to MNSI.
- An initial review is carried out to confirm whether the case meets the investigation criteria.
- A detailed and independent investigation begins. This may involve reviewing medical records, speaking with staff, and, importantly, listening to the family’s experience.
- Families are kept informed throughout the process. You should be told early on that an investigation is taking place and given opportunities to share your account.
- A draft report is prepared. Families are invited to review this and provide comments before the report is finalised.
The final report aims to explain what happened, why it happened, and what can be learned to help prevent similar situations in the future.
How long does it take?
MNSI aims to complete investigations within six months. However, every case is unique, and some investigations may take longer. While this can feel frustrating, it is often because a thorough and careful review is being carried out.
What are the possible outcomes?
An MNSI investigation is focused on learning and improvement. Outcomes may include:
- Safety recommendations
Suggestions to improve care at a local, regional, or national level within NHS maternity services. - Local learning and changes
This might include updates to clinical practices, guidelines, staff training, or communication and escalation procedures. - National learning
In some cases, findings contribute to wider changes in policy or national guidance.
If you are considering a legal claim, it is important to know that MNSI findings are not legally binding. However, they can provide helpful insight and evidence where concerns about care have been identified.
A final word
For many families, an MNSI investigation can be an important step in understanding what happened and why. While it cannot change the past, it can offer answers and contribute to improvements in care for others.
It is also important to remember that MNSI investigations do not assign blame or determine negligence. If you have concerns about your care or your child’s injuries, seeking independent legal advice can help you understand your options, even while an investigation is ongoing.
Maya Englesberg is an Associate in the Child Brain Injury team at Bolt Burdon Kemp.
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