Community midwives: referring patients with housing problems

This guide is for community midwives, student midwives, and maternity support workers who encounter pregnant women and new mothers living in poor housing conditions.

Why housing matters in maternity care

Housing quality has a direct impact on maternal and infant health. Damp, mould, cold, overcrowding, and pest infestation are linked to increased risk of respiratory illness in newborns, exacerbation of pregnancy-related conditions, low birth weight, and poor sleep and recovery postnatally.

Identifying and acting on housing problems is a legitimate part of maternity support. Referral pathways exist, and your patients have legal rights that can be enforced.

What housing problems should raise a concern?

• Damp and mould, particularly in rooms where the baby will sleep or where the mother is recovering postnatally
• No adequate heating, inability to maintain a safe room temperature, particularly in winter
• Overcrowding, families in one or two rooms where there is no private space for recovery and early infant care
• Structural disrepair, leaking roofs, broken windows, collapsing ceilings, or unsafe flooring
• Pest infestation, mice, rats, cockroaches, or bedbugs in the family home
• Homelessness or temporary accommodation, a patient with no stable home or in emergency accommodation
• Domestic abuse context, unsafe housing as a feature of a broader safeguarding concern

Disrepair affecting a pregnant woman or a newborn baby is given priority weight under the Housing Health and Safety Rating System (HHSRS), as pregnancy and infancy are recognised high-risk groups.

What are the patient's rights?

If the housing is privately rented: the landlord has a legal duty to keep the property in repair under the Landlord and Tenant Act 1985 and the Homes (Fitness for Human Habitation) Act 2018. The patient can report disrepair to the local council's environmental health team. If unresolved, a solicitor can pursue a housing disrepair claim on a no-win, no-fee basis, which can result in repairs being carried out and compensation paid.

If the patient is homeless or threatened with homelessness: a pregnant woman has priority need under housing legislation and should be accepted for rehousing or temporary accommodation by the local council on application. Refer to the council's housing options or homelessness team.

What can I do to help?

1. Document your observations, note in the records what conditions you observed and when, in clinical terms
2. Advise the patient to report in writing, tell them to contact their landlord in writing about the problem; this creates the formal notice that activates legal duties
3. Signpost to advice services, Citizens Advice, Shelter, or a local housing advice centre can advise on rights and next steps
4. Refer to housing disrepair solicitors, organisations like Support for Tenants take cases on no-win, no-fee; referral is appropriate where the landlord has been notified and not responded
5. Refer to the council's environmental health team, they can inspect and issue enforcement notices
6. Escalate via safeguarding channels where relevant, if housing is part of a wider safeguarding concern, follow your trust's safeguarding procedures

When is a safeguarding referral appropriate?

If poor housing conditions are creating a risk of significant harm to the baby or mother, and the family does not have the capacity or means to address this independently, a safeguarding referral to children's social care may be appropriate. Poor housing alone is rarely a safeguarding concern, but it can be a contributing factor alongside other risks.

Useful contacts for patients

• Support for Tenants, housing disrepair claims on no-win, no-fee: 0800 030 4669
• Shelter, housing advice and legal help: shelter.org.uk
• Citizens Advice, local drop-in or phone advice
• Local council housing options team, for homelessness and priority need

Sources

• Section 11, Landlord and Tenant Act 1985 (legislation.gov.uk)
• Homes (Fitness for Human Habitation) Act 2018 (legislation.gov.uk)

Related articles

• Eviction during pregnancy, your rights