Media

Women’s experiences of NHS maternity care outlined in new national survey

17 November 2010

Survey is first nationally to include data on involvement of fathers in pregnancy and childbirth

Key findings

* The majority of women are pleased with the care they receive during pregnancy and childbirth* Almost 9 in 10 dads are present at birth, and almost 9 in 10 are present at one or more ultrasound scans
* Women are seeing doctors or midwives earlier in pregnancy than in 2006
* Only around two-thirds of women were offered antenatal classes
* A quarter (24%) had four or more midwives providing care during labour.
* 70% of women stay 2 days or fewer in hospital after birth compared with 64% in 2006 and 53% in 1995

The majority of women are pleased with the care they receive during pregnancy and childbirth, according to a national survey of over 5,300 recent mothers by the National Perinatal Epidemiology Unit at Oxford University.

While some features of care have improved in recent years, there are important areas where improvements can be made.

The survey, funded by the Department of Health and conducted earlier this year, received responses from 5,333 women who gave birth across all areas of England in two weeks of October and November 2009. They gave their views on the care and information they received during pregnancy, birth and afterwards, in hospital and at home.

Most women in the survey praised the overall care from midwives and doctors during pregnancy, labour and birth, although women were less positive about the postnatal care they received. A small proportion – around 1 in 10 – did not feel they were always treated with respect or kindness and talked to in a way they could understand.

For the first time in any national survey of this type, questions were included on the involvement of fathers and partners. The data reported by mothers suggest that almost 9 in 10 dads are present at birth, the same proportion are present at one or more ultrasound scans, and most are involved in caring for the newborn ‘a great deal’.

‘Dads are often delighted, even bowled over to see their babies for the first time on ultrasound scans. The positive effect of this shouldn’t be underestimated,’ says Dr Maggie Redshaw of the National Perinatal Epidemiology Unit at Oxford University, one of the report’s authors. ‘Our survey reflects this and also shows that dads are significantly involved in caring for the newborn baby. However, only 71% of dads take paternity leave.’

The current study builds on previous national surveys in 1995 and 2006 in which NPEU was involved. It provides an up-to-date picture of maternity services, and allows a measure of changes over time.

Women are seeing doctors or midwives earlier in pregnancy than in 2006 (95% see someone by 12 weeks, compared with 90% in 2006 and 82% in 1995).

‘To see such a large proportion of women by 12 weeks into a pregnancy is amazing, given how it used to be,’ comments Dr Redshaw. ‘Seeing a health professional early is really important for managing women’s health. It allows better planning of the pregnancy care, early advice and early scans to monitor the baby’s development – particularly for those women that might require more care during pregnancy.’

There has also been a gradual change in awareness among women of their options for place of birth, whether that’s at a hospital, a midwife-led unit or at home. 67% of women knew that they could give birth at home, compared with 38% three years earlier, although only 3.4% actually did so.
Fewer women (34%) knew that it was possible to give birth in a midwife-led unit or birth centre separate from hospital, although not every option is available in every area of the country. In 2007, two-thirds of trusts only had obstetrician-led maternity units in hospitals, but since then many more have moved to offer midwife-led units on site as well.

The rate of caesarean section showed a minimal increase since 2006, from 23% to 25% of births. But as in 2006, less than 2% of the women who had caesareans (ie less than 0.5% of all the women surveyed) reported that they chose to have them without indicating any clinical reasons. ‘There is no evidence in our survey of women being “too posh to push”,’ says Dr Redshaw.

Only around two-thirds of women were offered antenatal classes, more often first time mothers. And half of those who were aware of classes being available said they were insufficient in number and were critical of the content.

‘Not every woman will want antenatal education or classes during pregnancy, but it’s important that women at least have the option,’ says Dr Redshaw.

Relatively few women had one midwife caring for them throughout their labour (18%). A quarter (24%) had four or more midwives providing care during labour.

While the goal is for one-to-one care once labour is established (one midwife looking after just one mother), it was not possible to measure this directly in the survey and may depend on the individual circumstances of each labour. Women who had longer labours, those with more complex deliveries, and first-time mothers were more likely to have more midwives. Women whose labours were 8 hours or less tended to have just one midwife, while 74% of those with labours of 18 hours and longer had at least four midwives looking after them at some point.

81% had not previously met any of the midwives that cared for them during labour and birth. However, most ‘always’ felt they had confidence and trust in the staff caring for them at this time.

Most women or their partners (76%) were not left alone at a time when it worried them either in labour or afterwards (76%). Again, women with longer labours were more likely to report this experience.

A move to shorter periods of postnatal care in hospital is apparent across these surveys. 70% of women stay 2 days or fewer compared with 64% in 2006 and 53% in 1995, although most feel that the length of stay was about right. In 2010, 98% of women were visited by a midwife at home and received around 3 home visits. This contrasts with 2006 when women had received an average of 5 postnatal visits. However, most women continued to feel there were enough visits.

The report also examined the care received by women from black and minority ethnic (BME) backgrounds, BME women born outside the UK, women living in the most deprived areas, women who left education at 16 years or under, and single women.

The findings suggest that women from these groups were more likely to access maternity services later and to be less aware of the options for where they could give birth. Some groups were more likely to report feeling they were not always treated with respect by their carers, that staff did not communicate well with them, and that they had fewer postnatal home visits when they would have liked more.

A full list of key findings is given in the executive summary of the survey.

For more information please contact Maggie Redshaw of the National Perinatal Epidemiology Unit on 01865 289712 or maggie.redshaw@npeu.ox.ac.uk

Or the University of Oxford press office on 01865 280530 or press.office@admin.ox.ac.uk

  • The survey, Delivered with care: a national survey of experience of maternity care 2010, will be freely available on the NPEU website when the embargo lifts: www.npeu.ox.ac.uk
  • The survey was funded by the Department of Health. The views expressed in the report are those of the NPEU authors and do not necessarily reflect the views of the Department of Health.
  • Anne Milton MP, Parliamentary Under-Secretary of State for Public Health, will refer to the survey during her talk at the Royal College of Midwives’ Annual Conference in Manchester at 2.00pm on Wednesday 17 November 2010.
  • The survey used a random sample of 10,000 women selected by the Office for National Statistics from births registered during two weeks in October/November 2009. Women whose babies had died and mothers under 16 years old were excluded from the analysis. The usable response rate for the postal survey was 54%, with 5,333 women participating. 14% of respondents came from black and ethnic minority groups.
  • Obtaining information about women's views and experiences is important for several reasons. Good care meets the needs of people as individuals, including their needs for choice, information, support and reassurance.
  • Dr Maggie Redshaw of the National Perinatal Epidemiology Unit at Oxford University, one of the report’s authors, said: ‘It’s important to listen to mothers and new parents about the care they receive, and this survey provides an insight into how maternity care is currently working from their point of view.
  • ‘Pregnancy and childbirth is a critical time in women’s, babies’ and families’ lives. The right information, support and healthcare can make all the difference. It is important to think about what women take away with them, and recognise that it is possible to make a difference for individual women and for the service as a whole.’
  • The 2010 survey follows an earlier survey of mothers conducted by NPEU in 2007 using similar methods, and a 1995 survey conducted for the Audit Commission that was analysed by NPEU. * A separate review of maternity care in England was carried out in 2007 by the Healthcare Commission (now the Care Quality Commission). This was published in 2008 as Towards Better Births. It was based on local surveys of recent mothers and data from Trusts. The Care Quality Commission has also carried out smaller-scale surveys in England this year at the level of the different NHS Trusts. Reporting of this data is scheduled for December 2010. http://www.cqc.org.uk/
  • The National Perinatal Epidemiology Unit (NPEU) is an independent research unit based at Oxford University set up in 1978 by the Department of Health. Although its remit covers England and Wales, the Unit's research and collaborative links are worldwide and its work has influenced national and international policy. The Unit has expanded considerably in recent years and now has over 80 staff including epidemiologists, obstetricians, midwives, nurses, paediatricians, social scientists, information specialists, economists, statisticians, and computing, administrative and clerical staff. The Unit sits within the Oxford University Division of Public Health.
  • Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University’s income and expenditure, and two-thirds of its external research income. Oxford’s world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu) and other prevalent diseases (such as cancer, stroke, heart disease and diabetes). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units in Asia (Thailand, Laos and Vietnam) and Kenya, and work at the MRC Unit in The Gambia. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for tuberculosis, malaria and HIV, which are in clinical trials.