Women seeking pregnancy health care earlier, survey finds

26 February 2015

  • 94% realise they are pregnant by 6 weeks, 96% seek care by 12 weeks.
  • More are seeing a midwife rather than a doctor at the start of pregnancy care.
  • Postnatal hospital stays shorter, women receive fewer midwife home visits.  

These were some of the key results from a national survey of more than 4,500 recent mothers last year in England, conducted by the National Perinatal Epidemiology Unit (NPEU) at Oxford University.

The survey found that 94% of women realised they were pregnant by six weeks. 96% saw a health care practitioner by 12 weeks, compared to 82% in 1995.

‘To see such a large proportion of women accessing care by 12 weeks into a pregnancy marks an important change’, said lead author Dr Maggie Redshaw. ‘Seeing a health professional early is really important for managing women’s health. It allows better planning of pregnancy care, early advice and early scans to monitor the baby’s development – particularly for those women who might need more care during their pregnancy.’

Changes in interaction with health-care providers

Women are increasingly likely to see a midwife rather than a doctor at the start of their pregnancy, the survey found. 66% of women still saw a GP first, but this is ten percentage points lower than 2010. During the same time period, the number who saw midwives went up from 20% to 29%. 

70% of women have hospital stays of two days or less after giving birth, compared with 68% in 2010, 64% in 2006 and 53% in 1995. However, most women in the survey felt that the length of their hospital stay was about right. Similarly, most women felt that they received enough midwife home visits after birth, even though the number of average home visits had dropped from five in 2006 to three in 2014. However, midwives are now more likely to visit babies older than ten days, which may reflect increased flexibility

Women were also more likely to report having enough information about their choices for care (71% compared to 60% in 2010) and enough information to help them decide about care (73% compared to 63% in 2010).

High levels of patient satisfaction

Women also continued to be satisfied with the care provided to them during pregnancy and birth, with only about 1 in 10 women reporting a negative experience.

However, compared to the 2010 survey, more women were unhappy with their care after birth.

‘What is important is to try and get it right for all women, not just the majority. The survey findings indicate some areas where women’s experience could be improved’, said Dr Redshaw.

85% of women had not previously met any of the midwives who cared for them during labour and birth, substantially higher than in previous surveys. More than a quarter had four or more midwives providing care during labour, and this figure was higher for first-time mums and for women with complications. Nevertheless, most women (81%) ‘always’ felt they had confidence and trust in the staff caring for them at this time, even though relatively few women (16%) had one midwife caring for them throughout their labour.

The positive effects of Dads

Dads and partners continue to be increasingly involved with pregnancy and birth. Almost 9 in 10 dads are present at birth and during ultrasound scans. Most dads are involved in caring for the newborn ‘a great deal’.

‘Dads are really pleased to see their babies for the first time on ultrasound scans. The positive effect of this can’t be underestimated,’ says Dr Redshaw. ‘Our survey reflects this and also shows that dads are significantly involved in caring for the newborn baby. However, only 66% of dads took paternity leave.’

The experience of different groups of women

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.

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 they were not always involved in decisions, and that they would have liked more postnatal home visits.

The survey, funded by the Department of Health and conducted last year, received responses from 4,571 women who gave birth across all areas of England. Women gave their views on the care and information they received during pregnancy, birth and afterwards, in hospitals and at their home. The current study builds on previous national surveys in 1995, 2006 and 2010 in which NPEU was involved. It provides an up-to-date picture of maternity services, and allows researchers to track changes over time.

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 +44 (0)1865 289712 or maggie.redshaw@npeu.ox.ac.uk

Alternatively contact the Oxford University News Office on +44 (0)1865 270046 or email news.office@admin.ox.ac.uk

Notes to Editors:

  • The report of the survey, Safely delivered: a national survey of women’s experience of maternity care 2014, will be freely available on the NPEU website (http://www.npeu.ox.ac.uk).
  • This is an independent report from a study which was funded by the Policy Research Programme in the Department of Health.  The views expressed are not necessarily those of the Department.
  • The survey used a random sample of 10,000 women selected by the Office for National Statistics from births registered during two weeks in January 2014. 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 47%, with 4,571 women participating. 16% 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. Women’s reactions to care around the time of birth can affect the way they care for themselves and their baby. It is also a window of opportunity for health intervention, as many women and their partners are in touch with services at this time. Some aspects of care can be assessed only by asking women, or are more practical to get this way. Women need to be the ones to say whether they received sufficient information, whether they were able to understand what was said to them, whether or not they were treated kindly, and to describe the quality of the services and facilities.
  • The 2014 survey follows earlier surveys of mothers conducted by NPEU in 2006 and 2010 using similar methods, and a 1995 survey conducted for the Audit Commission that was analysed by NPEU.
  • Separate reviews of maternity care in England were carried out in 2007, 2010 and 2013 by the Healthcare Commission (now the Care Quality Commission). These were based on local surveys of recent mothers and data from Trusts.
  • 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 Nuffield Department of Population 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.