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Concern at level of variation between maternity units

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Maternity units need more help to understand their performance and what they must do to improve services, say experts in maternity care.

This is one of the key messages to come out of the latest analysis of data from maternity services across England, which shows ongoing variation in the care women receive.

“We are concerned about the amount of variation identified”

David Richmond

The Patterns of maternity care in English NHS trusts report, published by the Royal College of Obstetricians and Gynaecologists in collaboration with the London School of Hygiene and Tropical Medicine, shows significant differences between trusts.

Overall, 55% of first-time mothers had some form of intervention during labour and delivery, but there was considerable variation in the types of intervention and results.

Emergency caesarean sections varied from 8% to 15% between trusts with the highest and lowest rates.

There were also variations in vaginal delivery procedures used for first-time mothers, with rates of instrumental delivery varying between 19% and 29% and episiotomy from 29% to 44%.


Dr David Richmond

David Richmond

The report authors said some variation in care was to be expected and could reflect efforts to tailor services to patients’ needs and wishes.

Differences in the quality of data submitted by trusts may also account for the variation, they noted.

However, they warned there was concern the differences between services may also mean not all women are getting the best care or that NHS resources are not being used efficiently.

“We are concerned about the amount of variation identified in this report,” said RCOG president Dr David Richmond.

“Although the exact causes are difficult to establish, it is paramount that maternity units have information about their services, as well as the ability to compare themselves to the national average and their peers.”

He said some trusts were successfully using data to identify issues and make improvements.

Examples include University College London Hospitals NHS Foundation Trust, which found it had slightly higher than average rates of instrumental delivery.

“Effective multidisciplinary reviews and shared seeking and implementation of solutions is vital to improve outcomes”

Louise Silverton

One course of action was to work with midwives and anaesthetic staff to maintain mobility in women who chose epidurals, as this has been shown to reduce prolonged labour and the need for instrumental deliveries.

The Royal College of Midwives said it was vital all trusts were supported to analyse their data and make changes, if necessary.

“This latest report shows that there are still concerns about variation between maternity services and the care they provide,” said Louise Silverton, RCM director for midwifery.

“It is unfortunate this continues and is mirrored in outcomes of stillbirth rate and perinatal deaths,” she said.

“The RCM believes more needs to be done for units to help them understand their statistics and to determine if action is needed,” she said. “This is relevant for those with low levels of intervention as well as the high ones.

“We know from various reports, and the recently published Better Births Maternity Review for England, that effective multidisciplinary reviews and shared seeking and implementation of solutions is vital to improve outcomes,” added Ms Silverton.

She said it was also important to ensure all women had the information they needed to choose where they wanted to give birth.

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