Background
Access to good quality maternity care is crucial for reducing the risk of maternal deaths stillbirths and neonatal deaths that can occur after or during labour. The provision of personalised care, continuity of care and safe staffing are also essential for improving health outcomes.
Pregnant women should be encouraged to access maternity services for a full assessment of their health and social care needs, risks and choices early in their pregnancy. The National Institute for Health and Care Excellence (NICE) guidance states that pregnant women should be supported to access antenatal care, ideally by 10 weeks into their pregnancy. This gives them the benefit of personalised maternity care and can improve outcomes and experience for mother and baby. We look at the proportion of women whose first antenatal visit is at 10 weeks and how this has changed over time.>
Continuity of care (receiving care from the same midwife or small team of midwives) throughout antenatal care, labour and postnatal care is also associated with lower rates of infant mortality and preterm birth. We look at the proportion of women who report seeing the same midwife for all their antenatal check-ups as an indicator of quality of care.
Babies aged less than 14 days may be admitted to neonatal hospital care for many reasons, and while not all admissions are avoidable, high levels of admissions could be due to failures in care provided at various stages of the maternity or neonatal pathway (including antenatal care, and care during and after birth).
Another important indicator of postnatal care is whether a mother’s mental health is adequately monitored, and support given. Up to 20% of women develop perinatal mental illness in their pregnancy and up to one year after birth. Mental health disorders can affect maternal morbidity and mortality and can impact the mental health of their child.
Finally, good staff health and wellbeing is associated with better care outcomes and is important for improving the services available to patients. Inadequate staffing levels and poor staff wellbeing have been worsened by the increasing pressures facing the NHS, particularly in the wake of the Covid-19 pandemic.
Timing of a woman’s first antenatal visit
The National Institute for Health and Care Excellence (NICE) guidance recommends that pregnant women should access their first antenatal visit by 10 weeks into their pregnancy. At the first antenatal visit, women are given information about screening tests, nutrition and baby’s development stages. The timing of a woman’s first antenatal visit is also a good indicator of access to maternity services. This chart shows the percentage of women receiving their first antenatal visit by 10 weeks of their pregnancy.
In 2021/22, 67% of women had their first antenatal visit by 10 weeks, an increase from 51% in 2012/13. Meanwhile there has been a fall in the proportion of women whose first antenatal visit was at 11-13 weeks of their pregnancy, from 28% in 2012/13 to 17% in 2021/22. Encouragingly, this indicates that access to timely antenatal care has been improving.
In the past decade, on average 17% of women have their first antenatal visit at 14 weeks or longer into their pregnancy. Although this fell steadily from 21% in 2012/13 to 13% in 2020/21, there was a small increase in 2021/22 to 16%. The Covid-19 pandemic may have exacerbated issues around access as infections, lockdowns and changes to the provision of maternity services all affected the way women could receive care.
Continuity of midwifery care
Continuity of care throughout antenatal care, labour and postnatal care is associated with improved outcomes as well as a positive experience of care. The Maternity Survey asks respondents “At your antenatal check-ups did you see or speak to the same midwife every time?”. Between 2019 and 2021, there was a significant improvement in the continuity of midwifery care, with 41% of women reporting that they saw or spoke to the same midwife at every antenatal check-up in 2021 compared with 37% in 2019. In 2022, however, the proportion of women who saw the same midwife at every check-up decreased back to 37%.
Admissions of babies under 14 days
High levels of emergency admissions soon after birth may be related to issues in the health assessments of babies or mothers before transfer or the result of poor postnatal care after the mother is discharged. The graph captures the number of emergency admissions of babies aged under 14 days in England between 2014/15 and 2020/21 expressed as a crude rate per 1,000 deliveries. The rate of admissions of babies under 14 days increased from 61 per 1,000 deliveries in 2014/15 to 78 in 2020/21, signalling worsening care.
Postnatal mental health
Improving access to perinatal mental health services is a key feature of the Maternity Transformation Programme. It is a vital part of women’s maternity care but can often go overlooked by health professionals. This chart shows the experiences of detecting postnatal mental health problems, information provision and support for women after they have given birth.
Nearly all women (96% in 2022) are asked about their mental health by a midwife or health visitor after giving birth. 81% of women are told who they can contact about emotional changes they might experience after birth. However, only 58% of women responded “Yes, definitely” when asked whether they received enough information about any emotional changes they might experience after giving birth.
Less than half of women (41%) responded “Yes, definitely” when asked whether a GP spent enough time talking to them about their mental health at their postnatal checkup, whilst 30% of women responded “Yes, to some extent”. This would indicate that mental health is widely asked about but that follow up support and information is lacking.
Experience of midwives compared to other NHS staff groups
The NHS Staff Survey asks questions on several issues including those relating to health and safety at work. In 2022, only 31% of midwives reported that they had adequate materials, supplies and equipment to do their work. This compares with 57% of nurses and healthcare assistants and 58% of those working in social care.
Just 7% of midwives agreed that there are enough staff at their organisation for them to do their job properly, the lowest proportion of any staff group. It signals that staff shortages are and continue to be a key safety issue in maternity units.
In addition, more midwives than any other staff group said they felt unwell because of work-related stress (63%) and were ‘often’ or ‘always’ burnt out because of their work (58%).
About this data
NHS Maternity Statistics:
NHS Maternity statistics include data on the gestational age of women’s first antenatal visit. From 2017/18, visits where the gestation period was unknown has been excluded from published data. Therefore, to ensure comparability, the number of visits with unknown gestation periods for years 2012-2017 have been removed in calculating percentages.
CQC Maternity Survey:
Respondents who answered that they didn’t know or couldn’t remember were excluded from published data tables.
2021 data collected during the third national lockdown for the Covid-19 pandemic reflects experiences of care throughout the pandemic. The 2021 maternity survey was also conducted as a mixed-mode survey with women given the option of completing the survey online or through the post.
A mixed-method approach was retained in 2022 due to its success in the previous year.
Continuity of Carer indicator:
In 2019, question B7 of the Maternity Survey was rephrased from “If you saw a midwife for your antenatal check-ups, did you see the same one every time” to “At your antenatal check-ups, did you see the same midwife every time?” The number of response options was also streamlined.
Postnatal mental health indicator:
In 2019, question F13 of the Maternity survey was rephrased from “Did a midwife or health visitor ask you how you were feeling emotionally?” to “Did a midwife of health visitor ask you about your mental health?”. The number of response options remained.
In 2019, a new question was included: F20 “At the postnatal check-up (around 6-8 weeks after the birth), did the GP spend enough time talking to you about your own mental health?”
NHS staff survey:
This indicator uses data from the NHS Staff Survey. The scores are calculated as the percentage of respondents who gave a specific answer to a question, or a defined set of responses to a series of questions.
For more information about the NHS Staff survey, including a basic guide and technical documentation for results, please see the survey website: nhsstaffsurveys.com.
Public Health England, Child and Maternal Health
The number of emergency admissions of babies aged 0-13 days is expressed as a crude rate per 1,000 deliveries.