Fewer women who gave birth in NHS maternity services last year had a positive experience of care compared to 5 years ago, according to a major new survey. The Care Quality Commission’s (CQC) latest national maternity survey report reveals what almost 21,000 women who gave birth in February 2022 felt about the care they received while pregnant, during labour and delivery, and once at home in the weeks following the arrival of their baby.
The findings show that while experiences of maternity care at a national level were positive overall for the majority of women, they have deteriorated in the last 5 years. In particular, there was a notable decline in the number of women able to get help from staff when they needed it.
Trend analysis was undertaken on 26 survey questions to understand how experiences have changed in the last 5 years. The results show a statistically-significant decline in positive responses to 21 of the 26 questions, four showed no change, and only one showed a statistically significant upward trend. Furthermore, of the 21 questions with downwards trends, results for 2022 were at the lowest point for the 5-year period in 10 cases.
Lack of Information and Availability of Staff Key Issues
The proportion of women who said they were given appropriate advice and support when they contacted a midwife or hospital at the start of their labour dropped from 87% in 2017 to 82% in 2022. Fewer people surveyed felt they were 'always' given the information and explanations they needed while in hospital - 66% in 2017 compared to 59% in 2022.
Availability of staff was also an area where more women expressed concern. In 2022, those surveyed were less likely to say they were 'always' able to get a member of staff to help them when they needed attention during labour and birth; 63% compared with 65% in 2021 and 72% in 2019. Results were lower still for care in hospital after the birth; with 57% who said they were 'always' able to get help - compared with 59% in 2021 and 62% in 2019.
Many of the key findings from the survey include a drop in positive interactions with staff and lack of choices about the birth. Just over two-thirds of those surveyed (69%) reported 'definitely' having confidence and trust in the staff delivering their antenatal care. Results were higher for staff involved in labour and birth (78%). In addition, while the majority of women (86%) surveyed in 2022 said they were 'always' spoken to in a way they could understand during labour and birth, this was a decline from 90% who said this in 2019. The proportion of respondents who felt that they were 'always' treated with kindness and understanding while in hospital after the birth of their baby remained relatively high at 71%, however had fallen from 74% in 2017.
Just under a fifth of women who responded to the survey (19%) said they were not offered any choices about where to have their baby. Also, less than half (41%) of those surveyed said their partner or someone else close to them was able to stay with them as much as they wanted during their stay in hospital. This was an increase compared with the 34% who said this in 2021, but the results were still well below pre-pandemic levels (74% in 2019).
The proportion who said that they 'definitely' received help and advice from health professionals about their baby’s health and progress after giving birth if they needed it, increased from 60% in 2021 to 63% in 2022. However, overall results since 2017 (71%) show a downward trend.
Less than half of respondents (45%) said they could 'always' get support or advice about feeding their baby during evenings, nights or weekends, in the 6- to 8-week period after having their baby, down from 56% from 2017.
On the positive side, scores increased in a couple areas, including quicker discharge from hospital and improved mental health services. Since 2017, there has been a positive upward trend for women who had recently given birth reporting that there was no delay with their discharge from hospital, from 55% to 62% in 2022.
Also, support for mental health during pregnancy is improving, although there remains room for further improvement. Nearly three-quarters of women (71%) said their midwife definitely asked about their mental health during antenatal check-ups; an improvement compared with 69% in 2021 and 67% in 2019. Furthermore, 85% said they were given enough support for their mental health during their pregnancy, compared with 83% in 2021. In terms of postnatal care, the vast majority of women surveyed said a midwife or health visitor asked them about their mental health (96% versus 95% in 2021 and 2019).
'Concerning Decline' In Care
Commenting on the survey, Victoria Vallance, CQC’s Director of Secondary and Specialist Care, said: "It is good to see that satisfaction among many of those surveyed remains high and there are some improvements in terms of mental health support and hospital discharge delays – despite challenges that we know services are facing. However, 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.
"It is vital that we listen to those who use and work in maternity services to understand what makes a good experience and what needs to improve. This will help ensure we can better support staff to provide the level of care that they want to be able to deliver every time and ensure a consistently good maternity experience for everyone. I hope that all trusts will use their individual survey results to help identify what changes can be made to drive up quality in their own services."
Maternity Services 'Categorically Falling Short'
In response to the survey findings, National Childbirth Trust Chief Executive, Angela McConville, 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 5 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 a testament to the many hard-working individuals in the NHS that most women were positive about their interactions with staff, but urgent action is needed to support staff to deliver high-quality, safe and personalised maternity care for every woman.
"Lockdown-era postnatal policies must end now. 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."