Maternity survey tracks changes in health care for mothers

A national survey of more than 4,500 recent mothers last year in England, conducted by the National Perinatal Epidemiology Unit (NPEU) at Oxford University, found that women were aware of their pregnancies earlier and sought medical care earlier than in previous years.

Women were also more likely to see a midwife rather than a doctor at the start of their pregnancy care, while postnatal hospital stays were shorter, with fewer midwife visits at home afterwards.

The survey found that 94% of women realised they were pregnant by six weeks. 96% saw a health care practitioner by 12 weeks, compared to 82% in 1995.

'To see such a large proportion of women accessing care by 12 weeks into a pregnancy marks an important change,' said lead author Dr Maggie Redshaw. 'Seeing a health professional early is really important for managing women's health. It allows better planning of pregnancy care, early advice and early scans to monitor the baby's development – particularly for those women who might need more care during their pregnancy.'

The survey, funded by the UK Department of Health and conducted last year, received responses from 4,571 women who gave birth across all areas of England. Women gave their views on the care and information they received during pregnancy, birth and afterwards, in hospitals and at their home. Women whose babies had died and mothers under 16 years old were excluded from the analysis. 16% of respondents came from black and ethnic minority groups.

The 2014 survey follows earlier surveys of mothers conducted by NPEU in 2006 and 2010 using similar methods, and a 1995 survey conducted for the Audit Commission that was analysed by NPEU. It provides an up-to-date picture of maternity services, and allows researchers to track changes over time.

Changes in interaction with health-care providers

The latest survey found that women are increasingly likely to see a midwife rather than a doctor at the start of their pregnancy. 66% of women still saw a GP first, but this is ten percentage points lower than 2010. During the same time period, the number who saw midwives went up from 20% to 29%.

70% of women have hospital stays of two days or less after giving birth, compared with 68% in 2010, 64% in 2006 and 53% in 1995. However, most women in the survey felt that the length of their hospital stay was about right. Similarly, most women felt that they received enough midwife home visits after birth, even though the number of average home visits had dropped from five in 2006 to three in 2014. However, midwives are now more likely to visit babies older than ten days, which may reflect increased flexibility

Women were also more likely to report having enough information about their choices for care (71% compared to 60% in 2010) and enough information to help them decide about care (73% compared to 63% in 2010).

High levels of patient satisfaction

Women also continued to be satisfied with the care provided to them during pregnancy and birth, with only about 1 in 10 women reporting a negative experience.

However, compared to the 2010 survey, more women were unhappy with their care after birth.

'What is important is to try and get it right for all women, not just the majority. The survey findings indicate some areas where women's experience could be improved,' said Dr Redshaw.

85% of women had not previously met any of the midwives who cared for them during labour and birth, substantially higher than in previous surveys. More than a quarter had four or more midwives providing care during labour, and this figure was higher for first-time mums and for women with complications. Nevertheless, most women (81%) 'always' felt they had confidence and trust in the staff caring for them at this time, even though relatively few women (16%) had one midwife caring for them throughout their labour.

The positive effects of Dads

Dads and partners continue to be increasingly involved with pregnancy and birth. Almost 9 in 10 dads are present at birth and during ultrasound scans. Most dads are involved in caring for the newborn 'a great deal.'

'Dads are really pleased to see their babies for the first time on ultrasound scans. The positive effect of this can't be underestimated,' says Dr Redshaw. 'Our survey reflects this and also shows that dads are significantly involved in caring for the newborn baby. However, only 66% of dads took paternity leave.'

The experience of different groups of women

The report also examined the care received by women from black and minority ethnic (BME) backgrounds, BME women born outside the UK, women living in the most deprived areas, women who left education at 16 years or under, and single women.

Women from these groups were more likely to access maternity services later and to be less aware of the options for where they could give birth. Some groups were more likely to report feeling they were not always treated with respect by their carers that they were not always involved in decisions, and that they would have liked more postnatal home visits.

A full list of key findings is given in the executive summary of the survey.