Women’s experiences of maternity care

Both CQC in England and NHS Scotland have recently reported on women’s experience of maternity care. The reports provide an interesting insight into maternity services, and CareKnowledge editor Jim Kennedy considers some of the differences that come with the systems north and south of the border:

I came at both of these reports as a non-participant observer, and certainly a non-expert – someone with long-ago, multiple experience as a father; and now second-hand experience as a grandparent. But women’s experience of child birth is such a defining one that it has implications for us all, particularly as it affects the future health and wellbeing of children, and their relationships with their parents.

Surveys like these are, of course, derived from non-experts and their findings should be directed at the public as well as at the expert audience – so, a first random thought is to wonder how much effort has been put into communicating the results of the surveys to current patients and intending parents.

The other immediate thought that came into my head is to note the different approaches that affect regulation and inspection in England and Scotland. In England, CQC, an independent regulator, constructs, delivers and analyses the survey. In Scotland, the NHS publishes the results of the survey, which was commissioned from the Nursing Midwifery and Allied Professions Research Unit.

And CQC presents its findings in potted form on its website pages – drawing attention to what the regulator thinks are the key issues. As far as I can see, NHS Scotland launches straight into the report itself.

Progress in maternity care

Both surveys are based on one originally devised by CQC, so I guess it should be possible to see emerging differences in the quality assessments being made across England and Scotland, but that would demand more time than I have in preparing this blog. It is a task also complicated by the different styles of reporting – and, in particular, by CQC’s comparative perspective (made possible by access to results from a similar survey carried out in 2010). The only previous summary carried out in Scotland was 15 years ago.

So without attempting to compare the two countries what were some of the findings/highlighted issues that caught my eye?

Well, in England, some progress is seen to have been made against a number of care indicators, including:

•  The proportion of women who said that they were always spoken to in a way they could understand during antenatal care and labour and birth
• More women feeling that they were always involved during antenatal care and labour and birth
• More women feeling that they were treated with kindness and understanding and had confidence and trust in the staff caring for them during labour and birth.

But, performance in other areas was not seen to have improved since 2010 and experiences were judged to be falling short of expectations. For example:

• Information and support were being provided inconsistently – and in some cases, basic knowledge such as medical history was not known
• Information needed to make choices was not consistently provided and the choices themselves were not universally offered to women
• Fewer women reported that they were not left alone during labour or birth at a time that worried them
• Almost one in five women felt that their concerns during labour were not taken seriously and some women felt that hospital wards, and toilets and bathrooms were not clean enough

As noted above, it is more difficult to get the overall picture from the Scottish report but against a broadly positive assessment, with a number of good practice points, some of its critical comments focus on:

•  The lack of information to enable effective choices about place and style of birth
• The fact that only about one in four women were offered a choice of home birth
• The fact that some women felt their calls for help during labour were not appropriately responded to, and their levels of anxiety were not understood by staff
• The overuse of ‘lying flat’ and/or stirrups delivery
• The fact that, during postnatal care in hospital, one third of women felt that they were not always treated with kindness and understanding

I think both reports emphasise the importance of relationships with midwives, with CQC’s making the particular point that, across antenatal and postnatal care, women who saw the same midwife each time tended to report more positively on some areas of the survey. Women who saw different midwives (and who reported that they didn’t mind seeing different midwives) also tended to have quite positive experiences of care as well. More negative responses on those same aspects of care came from women who had not seen the same midwife but wanted to.

Finally, if the surveys are based on the notion that effective maternity care makes a crucial contribution to the health and wellbeing of mothers and children, it is a pity that information on fathers’ opinions about the system is missing…