It can be rare to find maternity wards in hospitals that have been designed to accommodate the needs of partners or significant family members. However, limiting the time any new parent can spend with their newborn can send the message that their role is less-significant. In this article Dr Lisa Common, Consultant Midwife, Nottingham University Hospitals NHS Trust describes an improvement project where partners are encouraged to remain overnight with women who want them to.
The journey through childbirth and the immediate postnatal period is a transformative experience, yet maternity services have traditionally centred on the mother (or birthing parent) and the baby. For many fathers and non-birthing parents, pregnancy can be marked by a frustrating paradox. While they are expected to be a pillar of support for their partners and a loving presence for their newborns, they can sometimes find themselves relegated to the sidelines, feeling that their presence is tolerated rather than actively encouraged.
‘There is a significant body of evidence that demonstrates the importance of sensitive, attuned parenting on the development of the baby’s brain, in promoting secure attachment and the foundations for early language development. Preventing and intervening early to address attachment and parenting issues can have an impact on the resilience and physical, mental and social-economic outcomes of an individual in later life.’
Public Health England (2021)
Recognising the significance of encouraging both parents to establish an effective parent-infant relationship – a concept that benefits the emotional well-being of the whole family and lays the foundation for a child’s development – Nottingham University Hospitals NHS Trust (NUH) embarked on a quality improvement project.
Central to this project, and the key to its success, was the strategic use of the Plan-Do-Study-Act (PDSA) cycle, an iterative model for testing and refining change. The introduction of recliner chairs for partners staying overnight became the tangible focus of this quality improvement work.
The Driver for Change: A Call from Service Users
The catalyst for change at NUH was clear: service-user feedback from the Care Quality Commission (CQC) maternity survey (CQC, 2024). Before 2018, NUH consistently performed below the national average for the question D6:
‘Thinking about your stay in hospital, if your partner or someone else close to you was involved in your care, were they able to stay with you as much as you wanted?’
The data showed a persistent gap. In 2015, only 48% of NUH service users reported their partner could stay as much as they wanted, compared to 64% nationally. The issue was not just lack of space in rooms and bays not designed for partners to stay, but a lack of facilities too. This clear need for change set the objective for the first PDSA cycle.
Phase 1: Piloting Change with PDSA (2018)
Plan
The first step was a modest test of change. With a charitable donation from a local family, NUH decided to purchase 20 recliner chairs to be distributed across the four antenatal and postnatal wards.
A pre-implementation survey was conducted with responses from 56 staff and 68 service-users. The survey highlighted the core challenge: a large minority of staff were generally unfavourable to the change due to concerns over space (55% of staff), lack of privacy and dignity (47%), and safeguarding/safety concerns (49% combined). Conversely, service-users strongly supported the idea, citing ‘extra support’ and ‘to reduce anxiety, feel calmer and get rest.’ The plan involved:
- Consulting widely with internal and external stakeholders including; health and safety, infection control, legal services, security, safeguarding, and trade unions. Drafting guidelines, Standard Operating Procedures (SOPs), service-user leaflets and posters.
- Purchasing 20 recliner chairs and introducing them onto the four pilot wards
Do
The pilot project was implemented in August 2018. The 20 recliner chairs were deployed, and staff were expected to manage the new system, which allowed partners to stay overnight, using the new guidance.
Study
A post-implementation survey (November 2018 – January 2019) revealed a mixed picture. While service-user satisfaction improved dramatically – with up to 100% on one site supporting the change – over 90% of staff identified a range of challenges. These included; a lack of adherence to the guidelines; partners sleeping in hospital beds; increased noise/sound disturbance for other families sharing bays; inappropriate wandering; and partners using call buzzers for themselves.
Critically, the CQC survey data in 2019 provided a powerful outcome measure: NUH’s score jumped from 56% to 74%, meeting the national average for the first time.
Act
The pilot was deemed a success based on the CQC data, but the ‘Study’ phase highlighted critical flaws in the process, not the concept. The next PDSA cycle required changes to embed the cultural shift and manage expectations:
- Simplifying/redesigning the partner agreement.
- Improving antenatal communication of expectations for partners staying overnight and limitations of the facilities on offer by involving community midwives.
- Restorative work with staff that encouraged ownership of the initiative and consistent application of the guidelines.
- Communication of clear escalation processes for non-compliant partners.
Phase 2: Going Big and Co-designing (2022 Onwards)
The COVID-19 pandemic severely disrupted project progress. The CQC maternity survey scores for question D6 at NUH plummeted to 24% and 26% in 2021 and 2022. This was due to caution about lifting visitor restrictions too early and potentially exposing vulnerable patients to infection. However, the recovery period led to a new, larger PDSA cycle, inspired by a new local partnership between NUH and Small Steps Big Changes (SSBC), part of the National Lottery Community Fund’s A Better Start Programme. SSBC had launched a Father Inclusivity campaign and NUH applied for funding to support the re-launch of partners staying overnight.
Plan (Revisiting the Change)
The new plan was to ‘go big’ by providing a universal offer that included a recliner chair next to all 130 in-patient beds for dads and non-birthing parents to use, while also providing somewhere for mums and birthing parents to sit and feed their newborns in comfort. Crucially, this cycle embraced a co-design approach, involving parent champions, multi-disciplinary staff, commissioners and SSBC as critical friends in the selection of the most suitable equipment to purchase.
Do (Testing with Users)
Instead of simply sourcing the lowest-priced recliners, SSBC encouraged NUH to bring a range of different models onto the clinical wards for service-users and staff to trial, rate, and vote on. This grassroots procurement ensured the final selection was practical for staff to manoeuvre and clean, while being comfortable enough for partners to rest.
In addition, the initiative was bolstered by the simultaneous introduction of the Think Dads Dad Pack. This was an information resource that had been co-created by SSBC with different stakeholders, and translated into a range of different languages spoken locally. NUH ensured that all pregnant people were offered either a physical or digital copy of the pack at their booking appointment. Posters promoting the Dad’s Pack were also developed for the hospital clinics and featuring a QR code for easy digital download. Later on, NUH also gained access to the Co-ParentPad aimed at LGBTQI+ non-birthing parents.
Study (The Resulting Improvement)
The 2023 and 2024 CQC maternity survey results for question D6 clearly demonstrated the impact that the universal implementation of recliner chairs was making locally:
In 2024, NUH achieved a score of 94%, exceeding the national average by 31%. For NUH, the result for question D6 was identified as the highest performance measure across the whole survey.
Service-user feedback has been overwhelmingly positive, noting the chairs were comfortable and helpful for breastfeeding and skin-to-skin. NUH have encouraged other NHS maternity services to support partners staying overnight, demonstrated with a neighbouring hospital purchasing chairs for this purpose in 2024.
Act (Sustaining the Gains)
While the cultural shift towards inclusivity was achieved, the iterative nature of the PDSA model has also identified new issues related to sustaining the change.
An audit in December 2024 revealed 80 chairs needed repair and 29 needed replacement due to excessive wear and tear. The next cycles are focusing on:
- Securing an ongoing ‘repair and replacement’ budget by exploring creative funding solutions.
- NUH are working with the chair manufacturers to come up with spare parts for damaged chairs that will return them to ‘as new’ and keep them in service for longer – achieving financial efficiencies that will cost £10s rather than £100s.
- NUH are also working on information and education for staff and service-users about how to prolong the lifespan of the chairs by treating them gently so that the next family can enjoy them too. This will take the form of an A5 sized poster in a clear acrylic frame that will be placed on each cleaned chair.
- Addressing systemic issues, such as reframing the provision of food and linen for partners as parents rather than ‘visitors’.
- Continuing to refine inclusivity for parents who do not identify as fathers, contributing to cultural shifts towards fully gender-inclusive services.
This NUH project illustrates how the PDSA cycle can be an essential tool for healthcare improvement, allowing for incremental, learning-focused change. By starting with a pilot, studying both quantitative and qualitative feedback, and acting on the learning, NUH successfully transformed a service deficit into a gold standard for inclusive maternity care.
To hear about this project in more detail, you can access the Fatherhood Institute podcasts from 2023 listed in the references below or email Lisa.Common3@nhs.net.
Acknowledgements
The author gratefully acknowledges the generous financial support provided by both Nottingham Hospitals Charity and Small Steps Big Changes for this project.
About the author
Dr Lisa Common, Consultant Midwife, Nottingham University Hospitals NHS Trust
Email: Lisa.Common3@nhs.net
Key references
Care Quality Commission (2015) 2015 Maternity Survey. Accessed 21 October 2025 online at: https://nhssurveys.org/surveys/survey/04-maternity/year/2015/
Care Quality Commission (2024) 2024 Maternity Survey. Accessed 21 October 2025 online at: https://www.cqc.org.uk/publications/surveys/maternity-survey
DadPad (2025) Co-Parent Pad. A quick reference baby guide for LGBTQI+ non-birthing parents. Accessed 21 October 2025 online at: https://thedadpad.co.uk/lgbtqi-parents/what-is-the-coparentpad/
Father Inclusion Hub (2025) Think Dads Dad Pack. Accessed 21 October 2025 online at: https://fatherinclusion.org/hub/packs/small-steps-big-changes
Fatherhood Institute (2023) Podcast: Building father-inclusive approaches: Are you sitting comfortably? Making space for dads in maternity wards, to improve service quality and infant bonding. Part 1. Accessed 21 October 2025 online at: https://www.podchaser.com/podcasts/engaging-dads-5497809/episodes/building-father-inclusive-appr-188521199
Fatherhood Institute (2023) Podcast: Building father-inclusive approaches: Are you sitting comfortably? Making space for dads in maternity wards, to improve service quality and infant bonding. Part 2. Accessed 21 October 2025 online at: https://www.podchaser.com/podcasts/engaging-dads-5497809/episodes/building-father-inclusive-appr-188521198
NHS England (2023) Plan, Do, Study, Act (PDSA) cycles and the model for improvement. Accessed 21 October 2025 online at: https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf
National Lottery Community Fund (2025) A Better Start Programme. Accessed 21 October 2025 online at: https://www.tnlcommunityfund.org.uk/funding/funding-programmes/a-better-start
Public Health England (2020) Maternity high impact area: Improving planning and preparation for Pregnancy. Accessed 21 October 2025 online at: https://assets.publishing.service.gov.uk/media/5fd0b1338fa8f54d59e8b707/Maternity_high_impact_area_1_Improving_planning_and_preparation_for_pregnancy.pdf
Public Health England (2021) Early years high impact area 1: Supporting the transition to parenthood. Accessed 21 October 2021 online at: https://www.gov.uk/government/publications/commissioning-of-public-health-services-for-children/early-years-high-impact-area-1-supporting-the-transition-to-parenthood
Links to other resources for further information about why it is important that midwives and maternity services encourage bonding to help babies develop brain connections and avoid disorganised attachment
- This online resource and course provide interesting evidence-based learning about how early experiences get built into our brains and bodies: https://www.albertafamilywellness.org/what-we-know/the-brain-story/
- 6 minute animation about Adverse Childhood Experiences (ACEs) produced by Public Health Network Wales: https://www.youtube.com/watch?v=YiMjTzCnbNQ
- Bonding before birth and talking to baby during pregnancy. Created by the BBC on their CBeebies parenting site: https://www.bbc.co.uk/tiny-happy-people/pregnancy
- Activities for 0-3 month olds. Created by the BBC on their CBeebies parenting site: https://www.bbc.co.uk/tiny-happy-people/0-3-month-old-baby-development-activities
- The UK Government have launched the Best Start in Life website: https://www.beststartinlife.gov.uk/
Dr Lisa Common, Consultant Midwife, Nottingham University Hospitals NHS Trust
October 2025