Maternity care in England ‘deteriorating’

A health watchdog has sounded the alarm over a “concerning decline” in women’s experiences with maternity services.

Fewer women feel they always got the help they needed during labour and birth, many were disappointed at the amount of time their partners could stay with them after the delivery of their babies, and a significant number reported that they did not feel listened to when they raised concerns.

The Care Quality Commission (CQC) said it has noticed a “deterioration” over the last five years in the ratings women gave their care.

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It came as a major new national poll showed a “statistically significant downward trend” on most measures examined to track maternity care across the country.

In particular, concerns were raised about staff availability, confidence and trust, as well as kindness and understanding of staff.

Ratings also tumbled for whether women felt they had been treated with dignity and respect, the amount of information provided to mothers, and their concerns about being listened to.

Some 21,000 women across England who had received care at one of 121 NHS trusts took part in the national survey, which found:

– Women were less likely to report that they were always able to get help during labour and birth – down to 63% in 2022 compared with 72% in 2019.

– There was a decline in the proportion who felt they could always get help after birth in hospital – 57% said they were “always” able to get help, down from 62% in 2019.

– Some 63% said they received help and advice abut their baby’s health and progress – down from 71% in 2017 to 63% in 2022, although this was a slight rise on 2021 (60%).

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– Just over two-thirds (69%) reported “definitely” having confidence and trust in the staff delivering their antenatal care.

– Seven in 10 reported always being given the help they needed when they contacted midwives and health visitors after their babies were born – down from 79% in 2019.

– There has also been a downward trend for mothers “always” being treated with kindness and understanding while in hospital after the birth, from 74% to 71% between 2017 and 2022.

– Some 90% said their partner or someone else could be involved as much as they wanted during labour or birth – but this is still down from 96% in 2017.

– But just 41% of women felt that their partners had been able to be with them as much as they waned after giving birth – prompting a charity to call for a change in policy.

– Some 77% said that if they raised a concern during labour and birth, they felt it was taken seriously, down from 81% in 2017.

– And 85% said they were always treat with respect and dignity during labour, down from 89% in the 2019 survey.

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The report authors wrote: “At a national level the 2022 maternity survey shows that women’s experiences of care have deteriorated in the last five years.”

They noted that, out of 26 measures studied, there was a “significant downward trend” in 21 of those.

Victoria Vallance, from the CQC, said: “These results show that far too many women feel their care could have been better.

“The trend analysis carried out this year reveals a concerning decline over time, particularly in relation to accessing information and support and getting help when it was most needed.

“This reflects the increasing pressures on frontline staff as they continue in their efforts to provide high-quality maternity care with the resources available.

“It also echoes what maternity staff attending CQC’s roundtable event last year told us about the exceptionally demanding circumstances in which they are operating and the need for greater support to help manage the challenges they face.”

Commenting on the survey, Angela McConville, chief executive of the National Childbirth Trust (NCT), said: “Maternity services in England are categorically falling short of women’s expectations.

“A woman who gives birth today may have a worse experience of NHS maternity services than if she gave birth five years ago. Time usually leads to progress, but we’re seeing the opposite.

“Today, women are less likely to report getting the help they need during labour, birth and antenatally, to get information to make informed decisions about their care, and to feel that any concerns about their care are taken seriously.

“This is not all the impact of the Covid pandemic but is directly associated with long-term under-investment in the staffing of maternity services.

“It is unacceptable that less than half of women say that their partner or someone close to them was able to stay with them as much as they’d like after giving birth.

“Trusts must immediately enable partners’ presence at in-hospital postnatal care so that mothers are never left without food and water, emotional support, access to a bathroom and help to lift and feed their baby.”

Maternity care in the NHS has been thrown into the spotlight after several high-profile inquiries – including the Ockenden Review and the investigation into maternity services in East Kent.

Matthew Jolly, national clinical director for maternity and women’s health for the NHS in England, said: “The CQC survey results show the ongoing impact of the pandemic on maternity services, and while the majority of women were positive about their interactions with staff and the information provided, other findings show the implications of sustained workforce challenges and reinforce the need for further improvements to maternity services.

“We continue to take action to strengthen maternity services across the country – we’re investing £165m annually to grow our workforce, strengthen leadership and improve culture, while continuing to work closely with NHS trusts and our partners to make necessary improvements and ensure that we provide the best possible services for mothers, babies and their families.”