Women's views on NHS maternity care published
"Thousands suffer ‘frightening’ births in failing NHS care,” The Daily Telegraph reports, alongside headlines in the Daily Mail and BBC News website about “Worry as women left alone in labour”.
These headlines stem from a national survey of women’s experience during pregnancy, labour and birth in England, conducted by the Care Quality Commission.
The findings of the survey – in which 23,000 women took part – were mixed. The CQC concluded that there have been improvements in some areas of maternity care in the last three years. It says that there has been an increase in the number of women reporting feeling more involved during antenatal care and birth, and an increase in the number feeling they were treated with kindness and understanding.
However, the CQC maternity services report also found problems in some aspects of maternity care. Information and support were reported as being inconsistent nationwide, and more women reported feeling alone during labour or birth at a time that worried them. Twenty-five percent of women reported feeling alone during labour or birth in 2013 – an increase from 22% in 2010.
Who took part in the latest maternity survey?
More than 23,000 women who gave birth in February 2013 (in some trusts, in January and March) took part. The number represents nearly half the women who were asked (46% response rate).
Women were eligible to take part if they were aged 16 or over, gave birth in a hospital, birth centre or maternity unit or had a home birth. The women came from 137 NHS trusts in England.
What questions were women asked about their experience of maternity services?
The survey asked women about their experiences of antenatal care, care during labour and birth and in the first few weeks afterwards. It asked mothers about their access to care, staff communication, involvement in decision making, continuity and quality of care, among a host of other themes.
What did the CQC’s maternity survey find
Care during labour
- 77% of women felt they were always involved in decisions about their care antenatally and 74% during labour and birth
- 71% of women said that they were able to move around and find a position that made them most comfortable during labour and birth "most of the time"
- 78% of women said they definitely had confidence and trust in the staff caring for them during labour and birth
- 25% of women reported that they were left alone at a time that worried them during labour and birth. This is up from 22% in 2010
- 19% said their concerns during labour and birth were not taken seriously
- 25% said there was not time to use the pain relief they had planned, with some feeling they were not able to access pain relief quickly or they were given insufficient pain relief
Information about maternity care
- 59% felt they were always given the information and explanations needed
- 23% of women felt that midwives were not aware of their own and their baby’s medical history
Antenatal choice and continuity of care
- During pregnancy, 28% of women said they had not seen the same midwife every time, although they wanted to. Postnatally, the figure was 26%
- 38% of women were offered the option of a home birth, 35% the choice of giving birth in a midwife-led unit or birth centre and 16% in a consultant led unit. 18% of women felt they were not offered any choices
Cleanliness of maternity units
- 63% of respondents felt that the hospital room or ward was ‘very clean’, 32% ‘fairly clean’, 3% ‘not very clean’ and 1% ‘not at all clean’
- Respondents found toilets and bathrooms less clean than the wards, with just over half (52%) saying they were ‘very clean’, 38% ‘fairly clean’, 7% ‘not very clean’ and 2% ‘not at all clean’
- While 85% of women reported being treated with respect and dignity, 12% felt that this only happened sometimes, and 3% that it did not happen at all
What did women say about their experiences of maternity services?
As well as analysing answers to their questions, the report also looks at 8,000 comments made by the women. It found overall that 14.4% of the comments were positive and 85.6% negative. 99.6% of comments on access to care were negative, as were 90.1% on cleanliness.
Antenatal choice and continuity of care
For example: “It was a second pregnancy I was hardly seen by my midwife, often trying to contact her with concerns or to make an appointment was almost impossible I was fobbed off constantly.”
“We saw a different junior doctor in clinic every time and only saw the consultant once, which resulted in a lack of continuity.”
However, another woman says: “I am really pleased with the continuity I received in my antenatal and postnatal care – predominantly seeing the same midwife with the exception of her being on annual leave or days off. I felt this contributed to a positive experience in the care I received despite a difficult and traumatic labour and delivery.”
Information about maternity care
84% of women who commented on communication felt it was poor. For example, “I waited a very long time in labour ward room after giving birth. The room was cleared of beds etc. and I was left with a hard chair to sit on, after having stitches. I called for assistance and the senior midwife in charge was very rude and I found myself trying to diffuse the situation and her bad temper by saying that I was ok and sorry to have pressed the call button.”
The report also says that over a third of all the comments women made related to issues around quality of care. These issues concerned the physical care of women and their newborns, pain management through antenatal to postnatal care and discharge arrangements.
More than a third of the comments (927, or 36%) made about quality of care related to women being left unattended too long, either during delivery or during a postnatal stay in hospital. Women suggested this was because staff were too busy and therefore not available, or they were “inattentive” and “ignored women”.
Women described instances of being left unattended prior to and during labour, and immediately after the birth where they were left for long periods of time, often without access to working call buttons. For example: “Due to me not being listened to and being ignored when I was telling the midwives I felt labour had started. I was left in a room with other women and not checked for four and a half hours even though I went to them three times to tell them I felt my baby was coming.”
“I had stitches which I was told were dissolvable, a month later they were still there and my skin had covered them therefore I had to go to the hospital and have them removed, with gas and air.”
Many women felt strongly about issues around feeding their babies, with more negative experiences than positive. 41% said they felt inadequately supported in the process of breastfeeding or felt information was poor: “My little boy never latched on once whilst on ward (36 hours) and no nurse came to help. A nurse came and check his vital stats but did not give any advice at all about breastfeeding, despite only encouraging breastfeeding.”
“The views of the midwives were so different which really messed with my mind. Some were dead against formula feeding which made me feel very guilty.”
Cleanliness of maternity units
The report says a common theme from women who raised concerns on the topic of cleanliness was being left lying in blood/bloody bedding unless they could change it themselves. “Women were upset to find they had to contend with their own or other people’s blood” says the report.
There were 949 comments about staff, with maternity wards described as “severely understaffed” with “over worked staff" on postnatal wards in particular: “My main complaint about my stay at the hospital was the lack of staff, which is no fault of their own. You were often left for long periods of time as there were too many women there for the amount of midwifes/professionals available! The time I was in, there were two midwives looking after roughly 15 women."
Was media coverage of the maternity services accurate?
The reports in the media were generally accurate. The BBC, Telegraph and the Mail included comments from the Royal College of Midwives about staff shortages and also a comment from Sir Mike Richards, the CQC’s chief inspector of hospitals.
All focused on the “negative” figures from the report rather than the positive. For example, where the press release said 75% of women reported that they were not left alone at any time that worried them during labour, while the media focused on the 25% who were left alone.
Arguably, it is the latter figures that matter, if policymakers are going to use the report to improve services.
What comments did the CQC make?
The CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “This survey is important because it tells us what is important to women, what they feel is working and what needs to improve.”
“I’m encouraged there are improvements but in too many cases, the quality of care delivered is just not good enough. Women and their partners are being left alone when it worries them, toilets and wards are described as unclean and some women are not given the pain relief they had expected or planned to use in their birth plan.
“Feedback in the comments given to us show at times, a truly shocking picture of experiences that should be the most joyous time in a woman’s life, not the most frightening.”
What should pregnant women do to ensure they have good care during pregnancy birth and afterwards?
A good starting place for woman who are planning to or who are already pregnant, is the NHS Pregnancy and Baby Guide.
