Maternity services in the spotlight4th June 2007
The government recently set out its pledge for improved maternity services in the future. How have maternity services changed in recent years, and what is now being promised?
Changes over ten years
The Department of Health funded a survey by the National Perinatal Epidemiology Unit comparing maternity care in 1995 with that in 2005/06. Key findings included:
- 49% of women are now receiving all their ante natal care from midwives alone.
- The number of ante natal appointments per patient has decreased over the last 10 years.
- The number of women accessing ante natal care before 12 weeks gestation is increasing, but only 13% are accessing midwife services direct (as opposed to being referred by their GP).
- 27% of women felt they had a choice about where they had their ante and post natal appointments, and 19% felt they had a choice about who they had their appointments with.
- 97% of births are in hospital or birthing centres. 3% of births take place at home.
- 39% of women surveyed said they were only given the choice of a hospital birth.
- Use of ultra sound scans during pregnancy is on the increase compared to 10 years ago.
- Use of pethidine during labour is decreasing, whilst use of epidurals is at similar levels to those in 1995.
- Use of continuous foetal monitoring during labour has decreased.
- Rates of non-instrumental vaginal deliveries is decreasing.
- Caesarean section rates are increasing (17% in 1995 compared to 23% in 2006).
- Length of stay in hospital has dropped since 1995.
- Overall 80% of women were pleased with their care, but wanted more choice about where they had their baby.
The survey also highlights the following persistent and stark health inequalities:
- Women are 20 times more likely to die of pregnancy related complications if they and their partner are unemployed and are defined as from socially excluded groups within society. Single mothers are three times more likely to die of pregnancy related complications than those with partners.
- Infant mortality rates are six times higher amongst vulnerable and disadvantaged groups compared to more advantaged groups. They are 45% higher in deprived communities compared with affluent ones.
The Department has now published Maternity Matters, pledging more choice to women in how and where they are cared for during and after their pregnancies. By 2009 it offers the following four choice guarantees:
Continuity of care is another key theme, with women being promised care under the same trusted midwife throughout their pregnancy and afterwards.
Maternity Matters sets out a vision where a range of health and social care services are better integrated around the needs of the expectant mother, new mother and young baby in order to address the clear inequalities between advantaged and disadvantaged families identified in the NPEU survey. The role and extension of the Sure Start scheme gets particular mention as this becomes an increasingly well used and valued service for young families in need of extra help because of their social and financial circumstances.
The Royal College of Midwives has responded with reservation to the Department of Health's proposals because of the additional workload they will create. The RCM's own survey of midwifery managers recently revealed that:
- Two thirds think their units are under staffed.
- Two thirds of units were carrying financial deficits.
- Training budgets for midwives are being cut.
- Midwives frequently care for more than one woman in labour at any one time.
- There is increasing reliance on support workers supplementing the trained midwifery workforce.
Kings College London carried out research commissioned by the Department of Health into the use of support workers on maternity units. They found that there was significant variation across the country in the tasks that support workers carried out, and the training that they received. They concluded that there was no evidence for the new roles leading to increases in quality or value for money. A national training and employment framework for maternity support workers is called for.
The RCM is calling for 3000 more midwives to be recruited over the next five years to cope with increasing demand on services and the Maternity Matters proposals.
Never far from the headlines is the thorny issue of maternity unit closures and reconfigurations. The Conservatives have identified 43 maternity units under threat of closure this year due to financial and clinical service pressures. Frequently this is tied up with the future of local A&E and paediatric services because of the clinical linkages between the three services, and the need to make sure that babies and children are seen by appropriately qualified staff in an emergency. Dr Sheila Shribman, national maternity 'tsar', has proposed that maternity services across England should be configured into networks of maternity, neonatal and paediatric services. This means that some consultant led departments in district general hospitals would turn into midwife only led units, with consultant led services centralised in fewer regional centres. Public support and women's preference is often for local midwife led units, as demonstrated in a number of protests controversially supported by local Labour Party MPs earlier this year. Yet the same public does not want to see these units surviving at the cost of their local consultant led service.
- The Healthcare Commission has announced its intention to carry out a national review of maternity services across England.
- The Kings Fund is calling for evidence for its own independent inquiry into the safety of maternity services in England.
For more information on maternity services go to:
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Title: Maternity services in the spotlight
Author: Alison Sturgess-Durden
Article Id: 3030
Date Added: 4th Jun 2007