Results from a new survey of over 20,000 recent mothers in England present generally encouraging evidence about women’s experiences of maternity care.
Despite continuing challenges around staffing levels and demand, most women report positive experiences of person-centred maternity care – albeit with a number of areas where there remains scope for improvement.
The maternity survey is particularly interesting because it asks in detail about experiences right along the care pathway – from antenatal care, to labour and birth, and right through to postnatal support.
By asking mothers to report on all aspects of their care, it reveals some striking differences in experiences at different points.
”A larger proportion of mothers said they were ‘definitely’ given enough information to choose where to have their baby”
At the early stages of pregnancy, there were improvements in choice and continuity of care. A larger proportion of mothers said they were ‘definitely’ given enough information to choose where to have their baby – 58% in 2015 vs 55% in 2013. There was also a slight improvement in the proportion of mothers who saw the same midwife for each antenatal appointment – 36% said this in 2015 vs 34% in 2013.
During labour and birth, more women report excellent personal care.
Communication was generally effective – 89% in 2015 vs 87% in 2013 said that they were ‘always’ spoken to in a way that they could understand – and mothers ‘always’ felt that they were treated with respect and dignity (87% in 2015, up from 85% in 2013).
”75% said that they were ‘always’ as involved as they wanted to be in decisions”
A majority, 75%, said that they were ‘always’ as involved as they wanted to be in decisions about care during labour and birth – although this still leaves one in four who would welcome greater involvement, including one in 20 (6%) who did not feel involved at all.
Despite very good personal care, there were some concerning findings around delivery.
More than one in three wome, who had either a normal or assisted vaginal delivery reported that they gave birth in stirrups, contrary to best practice guidance, and this figure increased from 32% in 2013 to 35% in 2015. One in four women said that they were left alone at a time that worried them during labour or the birth of their child.
Results around postnatal care were more challenging. Once mothers returned home, they reported poorer continuity of care and there were some gaps in information and support.
”Only 28% of mothers saw the same midwife for each of their postnatal appointments and check-ups”
Only 28% of mothers saw the same midwife for each of their postnatal appointments and check-ups, despite the majority (78%) seeing a midwife no more than four times after returning home.
Although almost all mothers (97%) were asked how they were feeling emotionally, only 57% were given information about potential postnatal emotional changes. Similarly, only two in three women said that they ’definitely’ got enough help and advice about feeding their baby in the six weeks after the birth – although this did represent an improvement from 2013 (65% vs 63%).
As well as highlighting differences between groups and at different stages, the survey shows the influence of changes in service provision on people’s experiences.
”Very evident is a continuing trend towards a greater focus on midwives as primary caregivers for mothers”
Very evident is a continuing trend towards a greater focus on midwives as primary caregivers for mothers. In 2015, 37% said that the first health professional they saw when they thought they were pregnant was a midwife. The majority – 57% – still see a GP first, but the proportion whose first contact is with a midwife has climbed steadily from 32% in 2013 and a mere 19% in 2007.
Similarly, more women report being offered the choice to give birth in a midwife led unit: 41% said this in 2015 compared to 35% two years ago.
“More women report being offered the choice to give birth in a midwife led unit”
It might not matter to mothers what uniform a healthcare professional is wearing providing their care is of a good standard, but the changes are in line with evidence that midwife-led care units are the safest for women with low risk pregnancies (NICE, 2014).
Improved access to midwifes may reflect an overall increase in the number of midwives working in the NHS – although this is still reported to reflect a shortage of around 2,600 midwives in England (Royal College of Midwives, 2015).
Overall, there are many positives in the survey results, as well as some encouraging improvements.
”New mothers report very good personal care across pregnancy, particularly at the point of labour and birth”
New mothers report very good personal care across pregnancy, particularly at the point of labour and birth, and this should help to ensure that as many people as possible have the positive childbirth experience that they would aspire to.
But the results also highlight areas for improvement: including adherence to guidelines during delivery, as well as continuity of care and information provision following the birth.
With the full results of the survey – including organisational data – now published, all staff and providers should take the opportunity to closely review the results for their areas. They will find much to celebrate as well as vitally important evidence around where to target improvements.
Chris Graham is Director of Research and Policy; the Picker Institute