Putting health policy into practice is a notoriously challenging obstacle to overcome. From ‘Changing Childbirth’ in 1993 onward, maternity services have been striving to improve choice and continuity for women along with better outcomes and more personalised care.
‘Better Births’ - the latest maternity report - was published two years ago and one year after that the new mothers of England were asked to complete a survey of their experience of maternity care. Yesterday the Care Quality Commission announced the findings from over 18,000 mothers and has confirmed ‘positive results about the quality of maternity care being provided in the NHS … a testament to efforts and dedication of staff working hard to provide care for pregnant women and new mothers across the country’.
This is the right point to make: in a heavily stressed and understaffed NHS, midwives and their team colleagues have endeavoured to make most women’s experiences as good as they can be, and this is to be commended.
It is undoubtedly a welcome step forward that there have been improvements in women’s care, particularly in having choice over where they give birth and seeing a midwife they know and trust for antenatal appointments. The increased proportion of women seeing a midwife as the first contact in early pregnancy contributes to this as women will be speaking to a maternity specialist from the beginning.
However, although more women are positive about these experiences more work is needed to ensure all women receive the best quality of care. Trends of improvement are encouraging – and reflect the good work in the NHS towards implementing Better Births – but looking at the bare numbers is not always so reassuring.
The CQC highlights, for example, that ‘Fifty-nine per cent of women reported that if they needed help when they were in hospital after the birth, they were ‘always’ able to get a member of staff to help them within a reasonable time, a significant improvement of five percentage points’. While it is truly good to see the rise, this still means that 41% of women – about 270,000 a year - didn’t get the help they needed when they needed it.
New mothers in the postnatal ward are in a highly vulnerable period of their experience: recovering from the birth; often exhausted, hungry and thirsty after labour, surgery or both; anxious about feeding their newborn; desperate for support and advice, and distressed if this is unavailable or too long delayed.
It is encouraging that the number of women left alone in labour has reduced, however it is still of great concern that 23% of women are left alone during the birth of their baby: a frightening and dangerous experience. Some of these (8%) were in the late stage of labour, some (7%) just after the birth but 2% - over 13,000 women - reported being left alone during the actual birth: not an acceptable situation. This absence of midwives from women in labour and at birth reinforces the fact that staffing levels in some units are dangerously low and midwives are being stretched to the limit.
A point rarely included in the CQC’s own summary of findings is the continuously rising number of women giving birth lying on their backs with legs in stirrups. This has increased from 27% to 36% over 10 years and I have not seen any attempt to address this poor practice. Rightly, the report says ‘NICE intra-partum guidance does not recommend women giving birth in stirrups unless they need an assisted birth’ but falls short of any recommendation to stop women experiencing this undignified, often unnecessary and potentially harmful practice.
Postnatal care is an area now receiving wider attention after ‘Better Births’ described its ‘historic underfunding’ and urged that mothers have ‘better access to their midwife’. CQC reports more women (78% vs 74% in 2015) who ‘were told who they could contact if they experienced any emotional changes after the birth’, which is an important improvement.
However, fewer women reported that they received ‘enough’ information about emotional changes after having their baby. NCT’s #HiddenHalf campaign calls for more awareness and support around women’s feelings and psychological state at this time, since anxiety and low mood can lead to serious mental illness if left unrecognised.
Overall, among the current concerns about NHS funding and resources, we can be thoroughly cheered that improvements are being recorded and - importantly – in most cases they are part of a 10-year trend of better experiences.
But there remain obstacles to overcome. Maternity services need to keep moving in the right direction for mothers-to-be and new mums to get the care they deserve.