Maternity care varies across England

Birth Not everyone receives the same level of care, says the report

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Expectant mothers in England experience wide variations in their quality of care, says a report by doctors.

Official data suggests rates of inductions, emergency caesareans and assisted deliveries are twice as high in some hospitals as others.

The disparities suggest some women are not receiving the best possible care, warns The Royal College of Obstetricians and Gynaecologists.

The report will help frontline staff raise standards, says the government.

In the first report of its kind, The Royal College of Obstetricians and Gynaecologists (RCOG) analysed the performance of maternity units in England during 2011/12.

The research, carried out with the London School of Hygiene and Tropical Medicine, focussed on 11 indicators of the quality of maternity care, using data routinely collected by hospitals.

They included the number of induced labours, emergency caesareans after induction, deliveries involving instruments such as forceps, severe tears during labour and emergency readmissions of mothers after delivery.

A picture emerged of a wide variation in practice and outcomes at different maternity units.

Start Quote

The initial set of indicators suggests wide variation in both practice and outcomes between maternity units which is a source of concern ”

End Quote Dr David Richmond RCOG

For example, among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour (17% compared to 38%), emergency caesarean section after induction of labour (20% to 40%) and instrumental delivery (16% to 32%).

Complex needs

The research is the first step towards developing indicators that can be used by maternity services to monitor and improve quality of care, said Dr David Richmond, vice president of RCOG.

"The initial set of indicators suggests wide variation in both practice and outcomes between maternity units which is a source of concern for the specialty as we cannot be sure that every woman is getting the best possible care," he said.

"It highlights that specialist-delivered care must expand so that for women with complex obstetric needs - which may only become apparent during labour - care can be provided by trained clinicians 24 hours a day and seven days a week."

Health minister, Dan Poulter, welcomed the report, saying it would help raise standards for women and families across England.

"Our NHS is lucky to have many skilled and dedicated obstetricians and midwives looking after women before, during and after childbirth, and this report will help frontline maternity professionals to improve the care that they provide to women and their babies," he said.

The Royal College of Midwives said it would study the report carefully.

Mervi Jokinen, practice and standards development advisor, said: "Such data encourages maternity professionals to look at the way they are working and to consider how they can improve the services they provide for women."

Patient experience

RCOG says the data has been analysed in a way that allows fairer comparisons to be made between hospitals, taking into account factors that are beyond the hospital's control, such as the mother's medical history.

However, it says some of the variation could be due to differences in the quality of the data submitted by hospitals.

Meanwhile, a separate report by the National Childbirth Trust and National Federation of Women's Institute into women's experiences of maternity care was released on Thursday.

It said 67 out of 84 trusts (79%) did not meet the recommended staffing ratio of midwives in 2011, according to Freedom of Information requests.

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