Who needs emergency care in the year after giving birth?

Having a baby is among the most significant physical and emotional experiences of a person's life, and for most women, the year that follows is one of profound adjustment, recovery and vulnerability. It is a period that has rarely had the same attention in discussion about maternity services as the pregnancy and birth that precede it.

Maternity services in England have been under intense political and public scrutiny in recent years, with the Amos Review into failures in maternity and neonatal services the latest in a long series of reviews and investigations. Inequalities in who is most affected by the failures are stark and well documented: women from more deprived areas and from many ethnic minority groups face substantially worse maternal outcomes than their peers. 

An emergency trip to hospital is stressful for anyone. For a mother with a newborn to care for, that stress is compounded. Yet how often postnatal health problems are serious enough to send women back to hospital in an emergency – and who is most affected – remains poorly understood.

This report addresses that evidence gap directly. Using hospital data covering nearly 1.6 million deliveries across England over three years, we examine how common postnatal emergency hospital contacts are, who they affect most, and what risk factors – many of them preventable, and many carried into pregnancy from earlier in life – could be driving these inequalities.

Our analysis draws on linked hospital data covering almost all births in England between April 2021 and March 2024. We examined whether each mother had an A&E visit or an emergency hospital admission in the year following birth, and used statistical modelling to identify which factors – including ethnicity, deprivation, age and pre-existing health conditions – were associated with higher risk of these emergency contacts.

A particular strength of the analysis is that it uses hospital records from before the delivery, allowing us to identify pre-existing health conditions and examine how long women had been living with them before they gave birth. We also improved on the ethnicity data routinely recorded in hospital records – reducing the proportion of women with an unknown ethnic code from 19% to 3% – enabling us to analyse outcomes across 16 detailed ethnic groups rather than broad categories.

Findings

The scale of postnatal emergency hospital use in England is substantial. Our study covered nearly 1.6 million deliveries across three years. More than one in five of those deliveries (22%) were followed by at least one emergency hospital contact in the year after birth, whether an A&E attendance, an emergency admission, or both. Emergency admissions, which indicate more serious illness, occurred after 6% of deliveries. While these rates are broadly comparable to those seen in people of the same age in the general population, beneath these averages lies striking variation in who is affected and the context in which those people visit hospital as a matter of urgency.

Emergency contacts were most likely to occur soon after birth rather than being spread evenly across the postnatal year. Around one in 10 occurred within the first two weeks, and almost a quarter within the first six weeks – with a notable spike at five days after giving birth. The reasons women attended A&E were varied: abdominal pain (12%), chest pain (6%) and vaginal bleeding (5%) were among the most common, alongside more generalised presentations such as skin problems and injuries, though some 21% did not have a reason for their visit recorded. For those admitted as emergencies in the first six weeks, complications more directly associated with childbirth such as postpartum haemorrhage and infection were, unsurprisingly, relatively more prominent than later in the postnatal year.

To understand variation between different groups and investigate potential explanatory factors beneath the headline numbers, we used statistical modelling to account for multiple characteristics simultaneously.

We found that the overall figures mask stark disparities, shaped by deep-rooted deprivation and inequalities in underlying health. They also reflect a failure to provide the preventative care and targeted support that could genuinely improve outcomes for the women most affected, both before and during pregnancy. 

There is a clear deprivation gradient: 27% of deliveries to mothers living in the most deprived areas were followed by an emergency contact within a year, compared with 17% for those in the least deprived. 

Underlying and pre-existing health conditions were a major factor associated with the women most at risk. In more than two-thirds (67%) of deliveries in our study, the mother had at least one recorded health condition – including mental health conditions, obesity, diabetes, lung disorders, substance misuse or hypertension.

Each health condition we studied was associated with a higher risk of having a postnatal emergency contact, and the risks were greatest when conditions had been present both before and during pregnancy, pointing to the importance of health across the whole of a woman's life, not just the months around birth. 

Women with a mental health condition faced up to 79% higher odds of a postnatal emergency contact (meaning the chances of it happening were higher) than those with no such record. Those with obesity faced up to 26% higher odds, and those with lung conditions up to 45% higher odds. The seeds of postnatal emergencies are often sown long before the birth itself. 

Ethnicity also plays a distinct role in shaping risk. Women of all Black ethnicities were more likely than the overall average (of 22%) to go to hospital in an emergency during their baby’s first year of life. For example, 27% of Black Caribbean, 26% of Black African and 28% of mothers of ‘any other’ Black ethnicity had an emergency care visit, as did women of Pakistani (25%) and Bangladeshi (24%) ethnicities.

Our statistical models found that risks were substantially elevated for women of Black, Pakistani, Bangladeshi and ‘other’ Asian ethnicities even among those living in less deprived areas – suggesting that deprivation differences alone do not explain the inequalities, and that several other factors, including inadequate health care support and the complex effects of structural racism on health and health care access, are likely at play. Women of Chinese ethnicity had the lowest rates of any group, at 14%. 

Age was a very clear predictor of postnatal risk. Women aged under 20 had by far the highest risk of a postnatal emergency contact – 39% of deliveries to teenage mothers were followed by an emergency trip to hospital, compared with 18% for women aged 35 to 39. Risk fell steadily with age before levelling off for people in their mid-thirties onwards. 

Overall, deprivation emerged as an important predictor of postnatal emergency hospital use, holding across nearly all ethnic groups – including White British women, for whom living in the most deprived areas was associated with 29% higher odds of an emergency contact than living in less deprived areas. This held even for ethnic groups whose overall risk was otherwise close to average: people of White Irish and Mixed White and Asian ethnicity living in the most deprived areas were among the groups with the highest risks of all (up to 60% higher odds), despite having risks similar to White British women when living in less deprived areas. 

Implications for policy and services

National attention on maternity care has rightly focused on the safety and quality of care during pregnancy and birth, following a string of damning reviews and the establishment of a national taskforce, and now a commissioner for maternity and neonatal care, to drive improvement. But this report shows that a narrow focus on the maternity pathway alone will not be enough to tackle the inequalities and risks we have identified. Much of what underlies variation in postnatal emergency hospital use may lie outside maternity services altogether: in the health women carry into pregnancy, in entrenched deprivation, and in ethnic inequalities that cannot be explained by deprivation alone. 

In more than six out of 10 deliveries in our study, the mother had a recorded health condition such as obesity, a mental health condition or diabetes – conditions that are themselves unevenly distributed across the population, and often present well before pregnancy begins. 

Obesity, for example, is more common among women living in deprived areas and among women of Pakistani, Black Carribean and Black African ethnicity than among White British women, and is itself linked to a higher risk of diabetes and other long-term conditions. Tackling poor health in girls and women throughout their lives, not just once they become pregnant, is therefore central to improving postnatal health and reducing postnatal emergency hospital use. This means public health action well before conception, alongside more systematic support during pregnancy for those at greatest risk.

Mental health conditions were associated with the highest risks of all. Yet other research has shown that 40% of women do not receive the six-to-eight-week postnatal check at which mental health needs are meant to be assessed, and the health visiting workforce that supports new mothers in the community has shrunk by more than 45% since 2015.

Diabetes tells a similar story: its prevalence is rising, and is more than twice as high among women of Asian and Black ethnicity as among White women, yet pre-pregnancy care for women with Type 2 diabetes is known to be particularly inadequate for those from deprived and ethnic minority groups. Improving monitoring and control of diabetes before and during pregnancy – and ensuring rapid referral to specialist care when pregnancy is confirmed – should be a clear priority.

Deprivation deserves attention in its own right, not only as a factor that compounds ethnic inequality. Women living in the most deprived areas had higher rates of postnatal emergency hospital contact across nearly all ethnic groups, including White British women – and most of the women affected were White: 72% of the 350,000 postnatal emergency contacts in our study were among women of White ethnicities. Targeted support in the most deprived areas is essential, but policymakers should also recognise that a deprivation gradient exists across the whole population: use of emergency care after giving birth rose step-by-step with deprivation in our analysis, and was not an issue isolated to the very poorest areas.

After accounting for multiple characteristics, including deprivation, ethnic inequalities persisted, and in some cases were stark – women of Black, Pakistani, Bangladeshi and Other Asian ethnicities living in less deprived areas still faced significantly higher risks than less deprived White British women. This cannot be fully explained by socioeconomic circumstances alone. Understanding what lies behind these differences – whether gaps in access to care, or the wider effects of structural racism on health – will require qualitative research with the women most affected. Analysis that uses detailed, disaggregated ethnic categories, as we have done here, is also essential: grouping Bangladeshi and Indian women together as simply ‘Asian’ obscures very different risk profiles and needs.

There is also a more immediate opportunity in the postnatal period itself. Emergency contacts peaked at five days after birth, coinciding with a newborn health check-up, and nearly a quarter occurred within six weeks of delivery. Over 70% of A&E attendances did not lead to an admission, raising the question of whether better support in the community (or earlier in pregnancy) could have prevented some of these visits altogether.

This is an important test case for the government's ambition to shift care from hospital to community, and from treatment to prevention, at a time when NHS services are under serious strain. Locally, integrated care boards and local authority commissioners will need to pay attention to whether the right services are in place to prevent and manage health conditions before pregnancy, and whether the right balance of staff exists to provide community care in the postnatal period. Within hospital trusts, better recording of why women attend A&E in the first place – currently missing in more than one in five cases – would also help services design more effective support. 

Taken together, these findings point to a single conclusion: improving maternity care during pregnancy and birth, while necessary, will not be sufficient to reduce postnatal emergency hospital use or close the inequalities we have found. A genuine life course approach – one that addresses the health of girls and women long before they become pregnant, tackles deprivation across the whole population, and takes ethnic inequalities seriously in their own right – is needed if these risks are to be reduced.