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'Maternity care has improved but some areas can still do better'

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Results from over 20,000 recent mothers in England present encouraging evidence about their experiences of maternity care. 

Chris Graham 2015

Chris Graham 2015

Chris Graham

Despite ongoing challenges around staffing levels, most respondents of the Maternity Survey 2015 reported positive experiences of person-centred maternity care – albeit with some areas in which there is still room for improvement.

The survey asks about experiences along the whole care pathway – from antenatal care to labour, birth and postnatal support.

It provides rich evidence about the quality of individual services as well as continuity and coordination between providers – and reveals some marked differences.

In the early stages of pregnancy, choice and continuity of care improved. A larger proportion of mothers said they were “definitely” given enough information to choose where to give birth – 58% in 2015 versus 55% in 2013, while 36% said they saw the same midwife for each antenatal appointment – up from 34% in 2013.

During labour and birth, more women reported excellent personal care. Communication was generally effective – 89% in 2015 versus 87% in 2013 said they were “always” spoken to in a way they could understand – and mothers “always” felt treated with respect and dignity (87% in 2015, up from 85% in 2013). Most, 75%, were “always” as involved as they wanted to be in decisions about care during labour and birth – although this means one in four would welcome greater involvement and one in 20 (6%) did not feel involved at all.

Despite very good personal care, some findings around delivery were a concern.

More than one in three women who had a normal or assisted vaginal delivery said they gave birth in stirrups, contrary to best practice guidance – this figure rose from Chris Graham 32% in 2013 to 35% in 2015. One in four women said they were left alone at a time that worried them during labour or birth.

On returning home, mothers reported poorer continuity of care, with gaps in information and support. Only 28% saw the same midwife for each postnatal appointment and check-up, despite most (78%) seeing a midwife no more than four times after returning home. Almost all (97%) were asked how they felt emotionally, but only 57% were given information on potential postnatal emotional changes. Similarly, only two in three said they “definitely” got enough help and advice about feeding their baby in the six weeks after birth; this was an improvement on 2013 (65% versus 63%).

The survey also showed how changes in service provision affect experiences. Very evident is a continuing trend towards a greater focus on midwives as primary care givers for mothers. In 2015, 37% said the first health professional they saw when they thought they were pregnant was a midwife.

Most (57%) still see a GP fi rst but those whose initial contact is with a midwife has climbed from 32% in 2013 and 19% in 2007.

Similarly, more women reported being given the choice to give birth in a midwifeled unit – 41% in 2015 against 35% in 2013.

The changes are in line with evidence that midwife-led care units are safest for women with low-risk pregnancies.

Overall, there are many positives. New mothers report very good personal care throughout pregnancy, which should help ensure as many as possible have a positive childbirth experience. But the results also highlight areas for improvement, such as adherence to guidelines during delivery, continuity of care, and information provision post-birth. With the full survey results now published, all staff and providers should take the chance to closely review the findings for their area. They will find much to celebrate as well as vital information about where to target improvements.

Chris Graham is director of research and policy, The Picker Institute

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