NHS review recommends more choice and support in maternity care

More personalised maternity care is required for mothers in England, a new NHS review has recommended.

The National Maternity Review found problems with care, with half of all term stillbirths having one element of care that required improvement which may have made a difference to the outcome. Additionally, almost half of maternity services rated by the CQC found them as inadequate or requiring improvement.

According to the report, the varied quality of services led to serious incidents such as the deaths of 11 babies and a mother between 2004 and 2013 at Furness General Hospital in Barrow. The CQC described maternity care in England as “just not good enough” in 2013.

The review’s recommendations include trialling an NHS Personal Maternity Care Budget to give mothers more choice over how they give birth, community-based midwives who can support mothers throughout the pregnancy, and better postnatal and perinatal mental health care.

Baroness Julia Cumberlege, chair of the Maternity Review, said: “To be among the best in the world, we need to put women, babies and their families at the centre of their care. It is so important that they are supported through what can be a wonderful and life-changing experience.

“Women have told us they want to be given genuine choices and have the same person looking after them throughout their care. We must ensure that all care is as safe as the best and we need to break down boundaries and work together to reduce the variation in the quality of services and provide a good experience for all women.”

Other recommendations are a payment system that fairly and precisely compensates providers for delivering different kinds of care, multi-professional working that breaks down barriers between different professions and providers, and more assessment of the safety of care, with rapid referral protocols to specialised services and a national standardised investigation process for when things go wrong.

Cathy Warwick, CEO of the Royal College of Midwives (RCM), said: “I hope women and everyone working in maternity services will be pleased to read this report. The RCM is most pleased that the review’s key priorities include putting women at the centre of care and believes that personalising maternity services will help to achieve this.”

The Review found that maternal care in England is improving overall. In 2003-13, the stillbirth and neonatal mortality rate fell by 20% and maternal mortality reduced from 14 deaths in 100,000 maternities to nine. However, the average age of first time mothers has increased from 27.2 years in 1982 to 30.2 years in 2014 and the proportion of women who have conditions such as diabetes in pregnancy has increased, leading to more complex births. Additionally, about half of the cases of perinatal depression and anxiety go unrecorded.

Siva Anandaciva, head of analysis at NHS Providers, said: “Our members – NHS trusts and foundation trusts - tell us that the demand for obstetric and midwifery services is increasing, as well as the complexity of requirements with some mothers needing more specialised and costly care.

“This means that the service is under considerable pressure so the review’s timely focus on redesigning services to improve care and outcomes for mothers is welcome. In particular, the need for more effective working between midwife, obstetric, neonatal care and increased multi-disciplinary training to ensure that women have continuity of care throughout their pregnancy cycle – before, during and after birth. It’s important that the review continues to follow an evidenced based approach to improving care by reducing the variation in quality and safety across the service.”



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