Background The contribution of patients to their own safety is receiving increased attention, and there is some evidence that patients detect some suspected adverse events earlier than professionals. However, little is known about maternity care. We draw on data from two component studies from Birthplace in England and NIHR King's Patient Safety Research Programme. Both explored the context, experience and impact of women speaking up, which we define as ‘making assertive and insistent attempts to communicate concerns or safety alerts to staff’.

Methods Organisational case studies of 5 NHS Trusts in 4 health regions in England. Data collected from March 2010 to December 2011 included: observation of meetings and ward life (>200 hours); semi-structured interviews with staff, managers and stakeholders including user-group representatives (n=130) and postnatal women and birth partners (n=92). Data was analysed by team triangulation using NVivo8 software.

Results Half the women “spoke up” and a quarter gave safety alerts about issues they considered urgent including reduced fetal movements, signs of risk in labour, abnormal pain, feeling unsafe, and neonatal or postnatal pathologies. Women from a range of socio-demographic backgrounds were more able to speak up in the supportive presence of a partner or relative. Women reported that staff failure to listen had affected some clinical outcomes, their sense of safety, and trust in the system.

Conclusion Speaking up, when heard and responded to, can contribute to safety and improve women's overall experience of care. Ignoring women's concerns and safety alerts may lead to avoidable harm.