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Maternity care findings ‘serious cause for concern’

Half of women reported a NICE-defined ‘red flag’ event in intrapartum period

Louise Prime

Tuesday, 17 January 2017

“Serious cause for concern” has been found in the latest survey of maternity services in England and Wales, with more than half of women experiencing red-flag events, although there are also “many reasons for optimism”, the NCT and the National Federation of Women’s Institutes (NFWI) have reported. In response to the charities’ report, the Royal College of Midwives (RCM) has called for serious and sustained investment in maternity care, to address the ongoing shortage of midwives and underfunding of services.

Support Overdue: Women’s experiences of maternity services, 2017, which will this morning be presented to the Health Select Committee in Parliament, is based on the experiences of 2,500 women who gave birth in England or Wales during 2014, 2015, or the first half of 2016. It found that women were generally positive about their maternity care, which on the whole was respectful and provided by supportive and trustworthy members of staff. It also found that digital technology can improve women’s experiences and help midwives fulfil their public health mandate.

However, said the report’s authors, “the findings also give us serious cause for concern and continue to show that policy aspirations with regards to choice and personalisation are simply not being met.” They found scant progress, compared with four years ago, in measures meant to ensure better clinical outcomes, such as continuity of carer; and instances where standards “have declined by considerable margins”.

They found that:

  • 50% of women reported at least one of the NICE-identified red flag events (indicators of dangerously low staffing levels) during their intrapartum care.
  • 17% of applicable women did not experience one-to-one care from midwives during established labour.
  • 31% of women who required or received pain relief experienced a delay of 30 minutes or more in getting it while they were in labour.
  • 15% of applicable women said their immediate post-birth care, such as washing or suturing, was delayed.
  • For 24% of women who required other services (either before or following the birth), their midwife was unable or unavailable to make a timely referral.
  • 28% of women who required medication either during or following the birth experienced a delay in getting a prescription or a delay in receiving it.

Furthermore, postnatal care remains patchy. Almost a fifth (18%) of women did not see a midwife as often as they required postnatally, which is no change from four years ago. More than a third (36%) of these women said this caused them a great deal of concern; nearly a third (31%) said this resulted in a delayed diagnosis and treatment of a health problem (for them or their baby); and well over a quarter (29%) said they went to their GP, A&E, or walk-in centre instead.

The charities are joined by the RCM in calling for improvements to maternity services. RCM director for midwifery Louise Silverton said: “The fact that half of women have experienced a red flag event is hugely worrying. It is a sign of services under too much pressure, with too few resources and not enough staff.”

She added: “Women are not receiving the postnatal care they need with many having to seek help from an already stretched GP and A&E services.

“This lack of consideration of maternity services is highlighted in the NHS Sustainability and Transformation Plans (STPs). As RCM analysis recently found, many of the STPs make only passing mention of maternity services, if they are mentioned at all. This is not good enough.”

She warned: “Serious and sustained investment in maternity care is needed to counter the huge increase in births over the last decade or more, the increasing demands on the service and the historical lack of funding. … This report should be a red flag event for this Government, who should be doing their utmost to stop these red flag events for women and their families.”

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