Women are slightly more positive about their experiences of maternity treatment than previously, according to the latest survey by the Care Quality Commission.
The regulator’s survey measured the responses of 18,400 women who had given birth in February 2017 in services run by 130 NHS trusts across the country.
“The survey identifies a number of encouraging data trends showing improvements”
This is the fifth survey of its kind that CQC has carried out in order to help NHS trusts understand what women’s experiences are of their maternity care and to make improvements.
It showed the proportion of women who said they could always get help from a member of staff within a reasonable time after giving birth rose to 59%, up by 5% since the last survey on the area was carried out in 2015.
In addition, 88% of women said that they were always treated with dignity and respect during labour and birth, compared to 86% who said this in 2015 and 85% in 2013.
But issues remained on continuity in antenatal care. Just over a third of women, 38%, said they saw the same midwife at every antenatal appointment – though this was a 4% rise since 2013.
However, during these check-ups, significantly more women felt they were asked about their emotional state than the last time the survey was done – 64%, compared to 57% in 2015.
There was also an increase in the percentage of staff introducing themselves to women on maternity wards (86%), compared with previous surveys (82% in 2013 and 83% in 2015).
Once back at home, 78% of women said they received contact information about whom to talk to if they experienced emotional changes, up from 74% in 2015.
“Scope for continued improvement remains, particularly in relation to women’s choices about their antenatal care”
However, the feedback also highlighted problems or areas where positive results had slightly fallen back. Of women who raised a concern during labour and birth, 19% felt it was not taken seriously by healthcare professionals in charge of their care.
A small minority of women (3%) were told they could not use their planned method of pain relief because of a shortage of staff. Meanwhile, the proportion of women who said they gave birth while lying with their legs in stirrups has increased by one percentage point since 2015 to 36%.
There was also a decrease in the proportion of women who said that they were given information about contraception once home – 89% compared with 91% in 2015.
In addition, 96% of women had a telephone number to contact a midwife or midwifery team after leaving hospital, but this had fallen by one percentage point since both the 2013 and 2015 surveys.
According to a separate CQC report looking at “outliers” among the survey results, there were no trusts flagged as “much better than expected”. Nevertheless, there were four trusts whose overall performance was identified as “better than expected”, which were:
- East Cheshire NHS Trust
- North Cumbria University Hospitals NHS Trust
- Northampton General Hospital NHS Trust
- Shrewsbury and Telford Hospital NHS Trust
Meanwhile, results from the analysis showed that, overall, patients from five trusts had “worse than expected” experiences of maternity care:
- London North West Healthcare NHS Trust
- Milton Keynes University Hospital NHS Foundation Trust
- Croydon Health Services NHS Trust
- Birmingham Women’s and Children’s NHS Foundation Trust
- University College London Hospitals NHS Foundation Trust
Furthermore, three trusts were identified as “much worse than expected” when all questions were analysed simultaneously, said the CQC. These were:
- Barts Health NHS Trust
- The Rotherham NHS Foundation Trust
- Sandwell and West Birmingham Hospitals NHS Trust
CQC chief inspector of hospitals Professor Edward Baker has written to all trusts flagged as much worse by the outliers analysis.
Overall, Professor Baker said: “The survey identifies a number of encouraging data trends showing improvements in women’s experiences throughout pregnancy, during birth and postnatally, and it indicates a greater focus on women’s individual needs and choices.
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“However, the scope for continued improvement remains, particularly in relation to women’s choices about their antenatal care and ensuring enough information is available to support women through any emotional changes they might experience after giving birth,” he said.
“Our own inspection work of maternity services so far shows that the majority of trusts are providing high quality care – with over 60 per cent of hospitals rated as either ‘good’ or ’outstanding’ for maternity,” he added
The full 2017 results for England, as well as individual results for each trust are available on the CQC’s website.
Mandy Forester, head of quality and standards at the Royal College of Midwives, welcomed the survey results, describing them as “quite positive” and as suggesting that women were experiencing better care.
“Postnatal care in our maternity services is often underfunded and under staffed”
She said: “We are pleased to see improvements in the quality of information and access to help and support after giving birth been given to women and it’s also really encouraging to see that the proportion of women who said they were offered the choice of giving birth in a midwife-led unit or birth centre has increased since 2015.
“Continuity of care and carer has also improved slightly,” she said. “The findings show a small increase in the number of women who said they saw the same midwife at every antenatal appointment and this something the RCM believes that every woman deserves.
“We know that continuity of carer enhances women’s experience, supports safe quality care and makes effective use of scare midwifery resources, so we must do all we can to make this a reality sooner rather than later,” said Ms Forrester.
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“It is also very positive to see women reporting that their midwife or health visitor asked them how they were feeling emotionally during their postnatal care,” she said. “Postnatal care in our maternity services is often underfunded and under staffed.”
She noted that the postnatal period could “often be a very difficult time” for women when the highest level of care and support was needed by some. “It can also be an extremely exhausting and worrying time particularly for first-time mothers,” she said.
“Overall, the results indicate improvements in areas of maternity care since 2015, but there is still much more that can be done to ensure women are experiencing the best possible care and treatment during their pregnancy,” she added.
Summary: Responses to the 2017 survey show a number of notable trends
- The proportion of women who said they were offered the choice of giving birth in a midwife-led unit or birth centre has increased by seven per cent since 2013 (35% in 2013; 41% in 2015; rising to 42% in 2017)
- Over a third of women (38%) reported that they saw the same midwife at every antenatal appointment: a 4% increase since 2013
- 88% of women surveyed said that they were ‘always’ treated with dignity and respect during labour and birth compared to 86% who said this in 2015 (85% in 2013)
- The majority of women (77%) reported that they were never left alone during the birth of their baby at a time when it worried them. This compares to 74% in 2015
- Almost six in 10 women (59%) said they could ‘always’ get help from a member of staff within a reasonable time while in hospital after the birth: an improvement of 5% since 2015
- 66% of women felt they were ‘always’ given the information or explanations they needed after birth before returning home (compared with 58% in 2013)
- 98% of women said their midwife or health visitor asked them how they were feeling emotionally during their postnatal care, but a smaller proportion (57%) said they were ‘definitely’ given enough information about potential emotional changes they might experience after giving birth
- While there has been an increase in the number of women who reported being offered the choice about where to have their antenatal checks compared to previous years (29% in 2013 rising to 31% in 2017), 69% said they were not given a choice about this aspect of their care