Women’s experiences of maternity care have improved, but further progress is needed

12 December 2013

Women’s experiences of maternity care have improved over the last three years, but progress is needed in some critical areas, the findings of a survey published by the Care Quality Commission (CQC) show.

The 2013 survey of women’s experiences of maternity care in England shows some improvements since the 2010 survey but highlights concerns around continuity of care, support during labour and birth, cleanliness and other issues.    

The survey received responses from more than 23,000 women who had a baby in February this year and it covers all aspects of maternity provision; antenatal care, care during labour and birth and postnatal care.

One hundred and thirty-seven acute NHS trusts took part and their individual reports will help them compare their labour and birth services with those elsewhere in the country to identify good and poor performance*. 

The findings for England include:

• More women than in the 2010 survey felt they were always involved in decisions about their care, both antenatally (77 percent) and during labour and birth (74 percent)
• More women than in the 2010 survey said that most of the time they were able to move around and find a position that made them most comfortable during labour and birth (71 percent)
• More women said they definitely had confidence and trust in the staff caring for them during labour and birth, up from 73 percent in 2010 to 78 percent.
• More women than the 2010 survey reported that they were left alone at a time that worried them during labour and birth, up from 22 percent to 25 percent.
• Almost one in five women said their concerns during labour and birth were not taken seriously (19 percent)

The survey also explored continuity of care. For both antenatal and postnatal care, women who saw the same midwife each time tended to report more positively on areas of the survey. Those women saw different midwives and said that they didn’t mind tended to have also had quite positive experiences of care.  More negative responses  came from women who had not seen the same midwife but wanted to.

Some questions can be compared with results from the previous surveys but others, such as those on cleanliness were new in the 2013 survey. Just over half (52 percent) felt that toilets were ‘very clean’, over a third (38 percent) fairly clean and almost a tenth (nine percent) not very or not at all clean.

Women were able to provide comments at the end of the questionnaire and 10,007 did so; and the majority of comments were analysed and grouped into key themes such as access to care, continuity of care, and quality of care. In the comments some women:

• reported experiences of poor pain management with some feeling they were not able to access pain relief quickly or that they were given insufficient quantities to control the pain
• said they felt ‘bullied’ into breastfeeding and that the pressure to breastfeed made them feel isolated and guilty

One comment received as part of the survey reported:

‘The most upsetting part though, was that midwives and health visitors make you feel bullied into breastfeeding… I was desperate to breastfeed during my pregnancy, and I was devastated when I couldn't, but the comments and the way you are made to feel guilty is totally unacceptable

Although many comments noted the poor quality of care  there were also positive comments, which highlighted professional and competent staff, and staff who were attentive to women, for example:

‘My midwives during labour were fantastic. They allowed my mum to lead me through pushing and they really involved my little sister who was present’

CQC chief inspector of hospitals Professor Sir Mike Richards said: ‘This survey is important because it tells us what is important to women, what they feel is working and what needs to improve.

‘I’m encouraged there are improvements but in too many cases, the quality of care delivered is just not good enough. Women and their partners are being left alone when it worries them, toilets and wards are described as unclean, and some women are not given the pain relief they had expected or planned to use in their birth plan.

‘Further findings of note include those about continuity of care, these suggest to me that women do not mind seeing different midwives if the information and messages they receive is consistent.  

‘Feedback in the comments shows at times, a truly shocking picture of experiences that should be the most joyous time in a woman’s life, not the most frightening.’

The results from the survey will be fed into CQC’s new Intelligent Monitoring Tool.

Ends

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Notes to editors

• Some trusts with a small number of women delivering in February would have also included women who gave birth in January 2013, one NHS trust included women who gave birth in March.  The national patient experience programme is managed by CQC on behalf of NHS England. The Picker Institute Europe coordinates the survey programme on behalf of CQC.
• Forty-six percent of women eligible to complete the survey did so.
• The proportion of women responding to the survey who were first time mothers has increased from ten percent to 13 percent. It is likely that some of the experiences of women will be different if they have previously had children, and so some of the changes since 2010 could be explained by there being a different proportion of first time mothers responding to the survey.
• Some trusts could not offer an adequate sample size and were consequently not included in the survey.  NHS Trusts in England took part in the survey if they had a sufficient number of eligible women that give birth at their NHS trust during the sampling time frame.
• The survey was run in 2007 and 2010, with results available on the survey co-ordination centre website.
• The questionnaire was extensively reviewed for the 2013 survey and amendments were made to improve the insight collected. The redevelopment included analysis of the data, involvement from women about their experiences, from stakeholders and from NHS trusts. The changes made between years has limited the number of comparisons available to 2010.
• Results are available for trusts on the labour and birth questions, as all women would have definitely received care from the trust they were sampled from. More information on the attribution exercise that was completed as part of the survey is available here: NHS surveys website