Can the NHS afford to give mothers-to-be exactly what they want?
The NHS promises to be there for us from cradle to grave and the very start of that process is safer than its ever been in England.
But not all of the 600,000 or so births that happen each year go the way mothers plan them.
That’s not entirely surprising - no one ever said delivering a baby was easy and the best laid plans can go horribly awry.
But an independent review wants women to get far more choice and control over how they give birth.
And to make sure mothers-to-be get a more personalised service the review calls for Personal Maternity Care Budgets.
Your average low-risk birth in England costs around £3,000. But you won’t simply be able to take the cash and blow it on acupuncture or a C-section.
In fact, mums won’t actually see the money at all - instead it will go direct to the provider of their choice.
The report’s author Baroness Julia Cumberlege envisions local practices of four to six midwives operating in a similar way to GP practices, with standards closely policed.
So even if your own midwife isn’t always available, you should still be seen by someone who knows you and your family.
It would mean women could appoint their own midwife to ensure continuity of care or plump for an antenatal centre near work to make scans more convenient, but then choose a different hospital or birthing unit for the delivery, and somewhere closer to home for convenient postnatal care.
That sounds much the same as the way existing personal health budgets are used by people with long term conditions.
The plan now is to trial the new individual maternity budgets in a small number of areas before a wider roll out - although they would remain a voluntary choice.
Its a definite shift towards favouring more community based care - which is what women regularly say they want - but the report acknowledges there is a fine balance to be maintained between choice and safety.
And thats the big question here. Can the NHS afford to give mothers-to-be exactly what they want, when the service is still failing to deliver decent, consistent care across the country?
That was underlined by the dreadful failings uncovered by last years inquiry into the deaths of 11 babies at Morecambe Bay. The National Maternity Review itself admits there are still meaningful differences across England in the safety of care provided.
There is little point making informed choices about how to give birth if you find your chosen hospital is closed. Yet half of all maternity units had to shut their doors to new mothers at some point last year because they simply didn’t have the staff to cope. And one in four women reported being left alone in labour at a time when they were worried.
There is without doubt, an enormous amount to welcome in the review.
The commitment to a kinder, more personalised and family-friendly approach over the next five years, for example, along with calls for a “rapid redress” scheme which would stop families having to go through the courts when things do go wrong.
Promised improvements to better post-natal care and more joined up maternity and mental health services are also long overdue.
What might help an over-stretched NHS achieve all this a birth rate that after a decade of growth seems to be flattening out.
But with an ongoing shortage of midwives, there is much to be done if the Health Secretary is to achieve his aim of halving the rate of stillbirths, neonatal and maternal deaths by 2030.