The following news story appeared in Essentially MIDIRS, vol 4, no 6, June 2013, p24.
Two reports from different sources have highlighted where change is needed in midwifery care in parts of the UK.
The first, Patterns of maternity care in English NHS hospitals 2011/2012 (Knight et al 2013), carried out by the Royal College of Obstetricians and Gynaecologists and the London School of Hygiene and Tropical Medicine, highlights the wide variations in care delivered to women during childbirth and the resulting differences in outcomes in maternity units across England.
The report presents a series of indicators that can be used to compare the performance of English maternity units. It is the first of what will be an annual account by the RCOG of variation in care delivered to women during childbirth.
This project uses Hospital Episode Statistics (HES) data from 2011/12 that is routinely submitted by each NHS hospital. For the first time, this data has been analysed in a way that enables fairer comparisons to be made between hospitals. The researchers have controlled for factors that increase the risk of a poor pregnancy outcome, but which are beyond the control of the hospital, such as the medical history of the mother. The indicators (including: emergency maternal readmission within 30 days of delivery, third and fourth degree perineal tear rate amongst unassisted and assisted vaginal delivery and elective caesarean sections) reveal considerable variation among maternity units in England. For example, among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour, emergency caesarean section after induction of labour and instrumental delivery. This variation is a source of concern as it could suggest that not all women are getting the best possible care, or that NHS resources are not being used in the most efficient way.
However, the report’s authors caution against over-interpreting the findings. Some of the observed variation could be due to differences in the quality of the data submitted by hospitals, and differences in characteristics of included women that were not possible to control for.
The second report, Support overdue: women’s experiences of maternity services (Bourke 2013), by the National Federation of Women’s Institutes and the NCT also highlights wide variations in the quality and standard of care across different parts of England and Wales.
It sets out to assess the impact that the present shortage of midwives is having on service users by examining the real life experiences of 5500 women who have given birth in the UK over the past five years (three quarters of them in 2012). The authors also made Freedom of Information requests to 141 Trusts in England and Wales and the report includes insights gained from these about levels of care, maternity services and policy commitments made to women.
Findings include that: despite government pledges, many women are not being given choices when it comes to deciding where to give birth; maternity care from preconception to postnatal care is often fragmented; and many are not getting enough support in the postnatal period.
Cathy Warwick, Chief Executive of the Royal College of Midwives, said:
“The report paints a disappointing and worrying picture of our maternity services.
Women have been promised choice around their maternity care and this report clearly shows that that choice is being denied or is simply not available to far too many.
Postnatal care has been an area of concern for some time. This is a vitally important period for women who need support, guidance and advice when they return home after giving birth. Too often resources are taken away from this key area leading to fewer visits by midwives and less contact with them for women.
This report should be compulsory reading for those who will be organising maternity services in the new NHS structure and I urge them to take note and act upon its findings”.
Knight H, Cromwell D, van der Meulen J et al (2013). Patterns of maternity care in English NHS hospitals 2011/2012. London:RCOG.
Bourke G (2013). Support overdue: Women’s experiences of maternity services. London: National Federation of Women’s Institutes.