The National Maternity and Perinatal Audit (NMPA) has today (9 November) published a major clinical report that identifies areas of good practice in maternity care, as well as opportunities to deliver improvements.
The report reveals that while the vast majority of women have a safe birth, and despite on-going improvements in the safety of maternity services, variation exists in a number of clinical processes and outcomes in maternity care.
Data was used from 149 of 155 NHS trusts and boards that provide maternity care in England, Scotland and Wales and are based on electronic records of 696,738 births between April 2015 and March 2016.
The key clinical findings include how major obstetric haemorrhage occurs in around one in 40 women, but in some units the rate was as high as one in 20.
It also reveals that third and fourth degree tears occur in around one in 30 vaginal births, but in some units it was reported in up to one in 15 vaginal births.
Hospitals reported that about one in 80 babies require additional support in the minutes after birth, as indicated by a low Apgar score. In some units this was as high as one in 30.
Other key messages include how eight out of 10 babies in England receive skin-to-skin contact within one hour of birth. Of women whose smoking status was recorded at their first antenatal appointment, 14.1% were smoking in England, 15.9% in Scotland and 18.3% in Wales. There is wide variation in the proportion of women who were reported to have stopped smoking during pregnancy.
Fewer than half of pregnant women had a body mass index (BMI) within the normal range between 18.5 and 25, and one in five were obese with a BMI of 30 or over.
The report shows that over half of all births are to women aged 30 or over and one in seven first births are to women aged 35 or over.
RCM chief executive Gill Walton said: ‘The RCM very much welcomes this report and believes that there is much to take away from its findings that will allow not only midwives, but the entire maternity team to improve the care that they are providing to women and their babies.
‘The RCM has studied the clinical findings in this report and the level of maternal obesity is most worrying with fewer than half of pregnant women having a body mass index (BMI) that was within normal range. Being obese when pregnant can cause complications for women and their babies. Therefore it is vital that midwives have enough time to give advice and support, as well as access to specialist services that they can refer the woman in a timely manner.
‘There is also extremely wide variation in the proportion of women who gave up smoking during pregnancy not only in England, but right across the UK. The levels of those smoking during pregnancy remains high, so it is clear that much more work needs to be done to support women with smoking cessation. The recording of a women’s smoking status both at the initial booking appointment and at the end of pregnancy does need to improve in order for us to develop a clearer strategy on how best to tackle smoking in pregnancy.
‘We know that supporting women to manage their weight and to give up smoking is more effective when the woman and midwife have a close relationship - as occurs where there is continuity of carer.
‘This report is without doubt an invaluable resource which we would not have had without the dedicated work of our colleagues on the front line in England, Scotland and Wales entering data in maternity records every day. Further recommendations for clinicians contained in this report involve improved electronic record keeping. Therefore, it is of upmost importance that midwives have access to adequate technology to enable them to do this in an efficient and safe manner. Systematic record keeping is vital as it impacts on continuity of care and carer and is particularly important for multidisciplinary maternity teams.
‘On place of birth, the report shows that although women have a variety of options of where to have their baby, it is disappointing to see that they are not choosing midwife-led settings, despite NICE and The Birthplace Study both recommending this option for low risk and uncomplicated pregnancies.
‘The RCM hopes that maternity leaders will look at this audit and share good practice between units, so those with the highest variation can learn from those with the lowest and in turn improve the safety and quality of our maternity services.’
The report was commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme.
It is the first such collaboration between the RCM, RCOG and the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene and Tropical Medicine (LSHTM).
Access the full report here.
