Background
Access to good quality maternity care is crucial for reducing the risk of maternal deaths, stillbirths and neonatal deathsthat can occur during or after labour. The provision of personalised care, continuity of care and safe staffing are also essential for improving health outcomes. In this indicator, we track changes over time across different aspects of maternal care quality.
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 the quality of care.
Babies aged <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 during their pregnancy and up to one year after birth. Mental health disorders can affect new mothers’ 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 within the first 10 weeks of their pregnancy.
In the past decade, access to timely antenatal care has improved. In 2022/23, 62% 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 19% in 2022/23.
However, since 2020/21, improving trends in access have shown a reversal. The proportion of women who had their first antenatal visit by 10 weeks decreased, and those who had their visit 11 weeks or further into their pregnancy increased. 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 asked post-2023 respondents “At your antenatal check-ups did you see or speak to the same midwife every time?”. More than half the respondents (61%) saw the same midwife at every check-up or at most of their check-ups, whilst 25% saw the same midwife some of the time and 14% saw a different midwife at every check-up appointment.
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% (data not shown).
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 2022/23 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 84 in 2022/23, 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 2023) are asked about their mental health by a midwife or health visitor after giving birth. 83% of women are told who they can contact about mental health changes they might experience after birth. However, only 60% of women responded “Yes, definitely” when asked whether they received enough information about any mental health 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 31% 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. The reported experience of midwives is worse than all of the comparator groups above. In 2023, only 36.3% of midwives reported that they had adequate materials, supplies and equipment to do their work. This compares with 63% of nurses and healthcare assistants and 61% of those working in social care.
Just 12.4% 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 (58.1%) and were ‘often’ or ‘always’ burnt out because of their work (50.4%).
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.
In 2023, question B5 of the Maternity Survey replaced question B7 from “At your antenatal check-ups, did you see the same midwife every time?” to “At your antenatal check-ups, how often did you see or speak to the same midwife?”. The answers included “all of the time”, “most of the time”, “some of the time” and “never, it was a different midwife every time”. The answers from the two questions are not directly comparable.
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 the same.
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.