Maternity care in England still failing too many women and improvements too slow

Despite some improvements, far too many women continue to report problems in key areas of NHS maternity care. Findings from the 2024 NHS Maternity Survey show areas for improvement in all stages of maternal care – supporting the challenges identified by CQC’s national review of maternity services in England 2022 to 2024.

The survey, which heard from over 18,900 women who gave birth in January and February 2024, highlights awareness of medical history, help from staff, involvement in decisions to be induced, and provision of information in postnatal care as areas for improvement.

Antenatal care

Looking first at antenatal care, only around half (53%) of all respondents said their midwives or doctor “always” appeared to be aware of their medical history during their antenatal check-ups. This is an improvement from 46% in 2021, when the question was first introduced, but still leaves many women having poor experiences of staff awareness of medical history.

More positively, the proportion who said that they received mental health support as part of antenatal care has continued to rise – up to 89% from 88% in 2023 and 85% in 2022.

Maternity care: labour and birth

The proportion of respondents reporting that they were “always” able to get a member of staff to help when they needed it during labour and birth has fallen since before the pandemic (64% in 2024 compared to 72% in 2019). Three quarters (75%) of all respondents said they were “always” involved in decisions about their care during labour, but mothers reported poorer experiences of decisions about induction. Only 59% of respondents whose labour was induced said they were “definitely” involved in the decision to be induced.

However, encouraging results were found regarding the provision of information and advice on the risks associated with an induced labour. Seventy-four percent of respondents whose labour was induced said they were given appropriate information and advice (up from 69% in 2023 and 64% in 2022).

Postnatal care

The survey also looked at postnatal care. Amongst women who stayed in the hospital after giving birth, the proportion saying they were “always” given the information and explanations they needed has fallen to only 58%: a drop from 60% in 2023 and 66% in 2019. Similarly, only 54% reported “always” being able to get help from staff while in hospital after the birth (compared with 62% in 2019).

The survey reveals how experiences differ among various groups, and we find that respondents who had an emergency caesarean birth reported below-average experiences across a wide range of measures.

Jenny King, Chief Research Officer at Picker, said:

The safety of maternity services has been a focus of national policy in recent years with independent investigations, such as the Ockenden Review, recognising the need for improvement in the quality of services across England. The NHS Maternity Survey tells us that there is much work to do to ensure all users of maternity services are receiving safe, high quality, person centred care. Results demonstrate that across the pregnancy journey there are areas where the quality of care has fallen short of expectations and where experiences have deteriorated over the last six years.

Listening to women and families is fundamental to achieving safer care. This survey, which has been carried out regularly since 2007, provides important insight that should be used to drive quality improvement initiatives. We call on NHS organisations to review their detailed local results and use these – alongside involvement from local people – to identify priorities for improvement.

Featured image via the Canary