17 november 2010

Women’s experiences of maternity care show mixed picture

Health

Pregnant woman's shape.
The majority of women are pleased with the care they receive during pregnancy and childbirth.

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 study is also the first nationally to include data on involvement of fathers in pregnancy and childbirth.

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.

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. 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.’

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.

Dads involved ‘a great deal’

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.

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.

Dr Maggie Redshaw

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.’

Women more aware of their options

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.

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.

Midwife care during labour

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.

Shorter postnatal stays

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.

The full survey report is available on the website of the National Perinatal Epidemiology Unit.