More than 17,500 women have responded to the Maternity Survey 2018 and the results show disappointing progress in many areas that are important to mothers.
The Maternity Survey is the biggest source of data on people’s experience on NHS maternity care in England. The survey offers a valuable insight into the experiences of mothers along their maternity pathway, and this year it has shown that continuity of care and postnatal support in particular have shown disappointingly little progress compared to previous years.
Continuity of care is about ensuring that women are cared for by the same midwife or small team of midwives throughout their maternity journey. Research suggests that this approach is linked to a variety of positive outcomes including improved safety and a reduction in miscarriages.
Key measures of continuity of care have seen small improvements between 2015 and 2017, but worryingly these have now been reversed. Nearly one in three (28%) women didn’t see the same midwife for all of their antenatal check-ups despite wanting to. There were similar results for postnatal care where 26% of women reported that they didn’t have continuity of care postnatally. Both of these results represent an increase of 1 percentage point since 2017.
The Picker Principles of Person Centred Care recognise that providing a sense of continuity throughout a person’s care journey is vital to ensuring that they have a good overall experience. This is a key area of focus for the NHS and has been highlighted in both the 2016 Better Births report and more recently the NHS Long Term Plan. A new question in the survey this year shows that only 7% of women experienced continuity of care over the entirety of their maternity pathway. In the NHS Long Term Plan, a target has been set for 20% of pregnant women to have the opportunity to have continuity of care in 2019. These results suggest that there is still a significant amount of work to be done to make this a reality.
Postnatal support is care provided to women within their community after they have left hospital. Mental health support is a key part of this care as it can play a major role in influencing the life chances and wellbeing of the woman, baby and family.
Encouragingly, 98% of women reported that they were asked how they were feeling emotionally during their postnatal check-ups. However, the survey also revealed that just over half of all women (56%) ‘definitely’ received enough information about emotional changes they might experience after giving birth. Almost one in four (23%) mothers said that they were not told who to contact for advice about emotional changes they may experience after giving birth.
These results raise the concern that while there is an awareness of the importance of postnatal mental health care, not enough is actually being done to provide women with the support they need. A key principle of person centred care is providing people with reliable, high quality and accessible information at every stage of their healthcare journey.
However, there were some findings from the survey that show encouraging improvements. The number of mothers being given a choice of whether to give birth in a midwife led unit or a birth centre has risen by ten percentage points since 2013. This year’s survey showed that 45% of mothers reported that they were given the opportunity to make this decision. Choice is a key theme in the Better Births report, which makes the recommendation that “most women should have access to three types of birthplace by 2020”. So, while it is positive to see this improvement, it must be recognised that many women said they were not given this option, and this focus on providing choice will need to continue in order to meet this recommendation.
Jenny King, Chief Research Officer at Picker, commented:
“Proposals seen in the Better Births report and more recently the NHS Long Term Plan have provided a welcome focus on the delivery and improvement of person centred care for those using maternity services. This includes key aspects that we at Picker consider to be fundamental to the delivery of high quality care such as postnatal support, choice, and continuity of care.
Results from the Maternity Survey help us to understand quality from the mother’s perspective and these latest results reveal that there is still work to do to make the ambitions of Better Births and the Long Term Plan a reality. But by using this feedback, the NHS can inform change that is centred on what matters most to mothers.”
Notes to Editors
- Picker is an international charity working across health and social care. We believe in high quality person centred care for all and promote this by measuring and encouraging the use of staff and patient feedback.
- You can read about the Picker Principles of person centred care here:https://www.picker.org/about-us/picker-principles-of-person-centred-care/
- The Better Births Report: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
- The NHS Long Term Plan: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
- The CQC survey report on the survey findings: https://www.cqc.org.uk/publications/surveys/maternity-services-survey-2018
- Research that supports the claim that continuity of care is linked to a variety of positive outcomes, including improved safety and a reduction in miscarriages: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004667.pub5/full