Only a minority of NHS providers report that women see the same midwife for most care contacts but more co-located midwife-led units are being set up to boost patient choice, an audit has found.
The first findings from the National Maternity and Perinatal Audit (NMPA) have been published today, describing how maternity and neonatal care is provided across England, Scotland and Wales.
“All units need to take this opportunity to benchmark their services against others”
Only 15% of trusts and boards reported that women see the same midwife for most care contacts in the antenatal, intrapartum and postnatal period, including care in labour from a known midwife.
More positively, 84% of sites that monitor one-to-one midwifery care during labour reported that at least 95% of women received this level of support.
In addition, 95% of trusts and boards said they had multi-professional team training for midwives and doctors working together on obstetric emergencies and over 80% had it for foetal monitoring.
The authors of the audit report also highlighted a steady increase in the number of midwife-led units co-located with obstetric units, which has quadrupled in the last decade to 124.
“It is worrying that so few women are seeing the same midwife or group of midwives”
They said two thirds of obstetric units were now co-located with an alongside midwife-led unit, resulting in more choice for women about where they can plan to give birth.
However, this trend differed across the country, with Wales doing much better than Scotland – only 38% of units in Scotland being co-located, compared to 100% in Wales and 68% in England.
In addition, only 22% of trusts and boards offered the full range of birth settings – including alongside midwife-led units and obstetric units, home birth and freestanding midwife-led units.
Such low numbers may be due to geographical factors, such as remote or rural locations, suggested the report’s authors.
They said that, where feasible, women should have access to all four birth settings either within their own maternity service, or in close collaboration with neighbouring services.
Meanwhile, 97% trusts and boards said they used an electronic maternity information system to record the care of women and babies, helping to ensure safe, transparent and effective care.
But only half of trusts reported that these records were fully accessible to community midwives and just a tenth said that women themselves had access to their electronic maternity record.
The audit also found that the number of planned postnatal home visits or postnatal clinic appointments after an uncomplicated pregnancy and birth ranged from two to six between services.
“These staffing and capacity issues must be addressed as a matter of urgency”
Services should examine the reasons for this variation and national standards should be developed, said the report – titled the National Maternity and Perinatal Audit: Organisational report 2017.
It also called for the expansion of transitional care, to ensure mothers and babies were kept together when they needed additional support and avoiding unnecessary admission to a neonatal unit. The audit found 64% of sites with a neonatal unit provided transitional care.
In addition, the research revealed the scale of decisions being made to temporarily close maternity units to new admissions during the 2015-16 financial year, which ended in March.
The audit indicated that, during the past financial year, 45% of obstetric units, 27% of alongside midwife-led units and 23% of freestanding midwife-led units closed at least once.
But only a few closed often, being more likely to be mostly large urban or suburban units, said the report. The total length of time they were closed ranged from less than an hour to 28 and 32 days for midwife-led and obstetric units, respectively.
The data on temporary closures follows figures revealed earlier this week by the Labour Party, which suggested nearly half of England’s maternity units were closed at some point in 2016.
The data revealed that 42 hospital trusts that responded to a Freedom of Information request said they temporarily closed maternity wards to new admissions at least once in 2016.
The new audit, which was commissioned by the Healthcare Quality Improvement Partnership, is the largest evaluation of NHS maternity and neonatal services undertaken in Britain.
Launched in 2016, it is intended to help maternity and neonatal services to identify good practice and areas for improvement in the care of women and babies.
All 155 NHS trusts and boards providing on-site birth care across England, Scotland and Wales completed the detailed survey that was used to collect data for the audit.
Today’s report is the first to come from the audit. It provides comprehensive information on how maternity and neonatal care is delivered by the NHS in England, Scotland and Wales, covering maternity and neonatal care settings, availability of services and facilities, and staffing.
A second report from the audit, due to be published later this year, will examine how clinical practices and outcomes for individual mothers and babies vary between units.
The audit is a collaboration between the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene and Tropical Medicine.
Dr Tina Harris, NMPA senior clinical lead for midwifery, said: “This survey found that there is no such thing as a ‘typical’ maternity unit, and this may be because services are organised in different ways to reflect the needs of the local populations they serve.
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“Nevertheless, all units need to take this opportunity to benchmark their services against others and against national standards where these exist,” she said.
“This will allow consideration of areas for improvement to ensure a high-quality service, which enables choice and provides the best possible care for women and their babies,” she noted.
Dr Jane Hawdon, NMPA senior clinical lead for neonatology, described the 100% participation rate in the audit as a “fantastic achievement” that demonstrated the “clear commitment” of units to improve care.
Responding to the findings, Mandy Forrester, the RCM’s head of quality and standards, said: “There is much to be optimistic about, but it also throws up some issues of real concern.
“The RCM is encouraged to see many women getting one-to-one care in labour, but we want to see this at 100%,” said Ms Forrester.
“We do however have concerns about what services maybe being affected to ensure one-to-one care actually happens, as this could potentially be at the expense of midwives being pulled out of community services as well as it affecting areas such as home births and vital postnatal care because of existing midwife shortages.
“It is worrying that so few women are seeing the same midwife or group of midwives. Continuity of carer is crucial to ensuring safe, high quality care. Another concern is that so many women cannot get access to their electronic pregnancy records; this disempowers women and needs urgent attention.
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Professor Lesley Regan, president of the RCOG, described the audit as “ambitious and important”.
“While the results show some promising developments, it also highlights where improvements must and should be made, for example, ensuring all women can choose from the full range of birth settings, have continuity of care during pregnancy and access to their electronic maternity records,” she said.
She added: “The difficulties in securing staffing in obstetric units is particularly worrying. Moving forward it is anticipated that rota gaps will persist and worsen in most units.
“Stretched and understaffed services also affect the quality of care provided to both mothers and babies,” she said. “If the UK governments are serious about improving the safety of maternity services, these staffing and capacity issues must be addressed as a matter of urgency.”