What women say about their care
A woman's experience of maternity care is important, not only to her emotional well-being but to her mental and physical health. Indeed, women often say they never forget what happened during their births.
Yet the data on this is limited, with only the Care Quality Commission (CQC) maternity survey providing regular direct comparisons over time and by trust in the UK only. This makes it difficult to monitor whether women's experiences of maternity care is improving or not and how they differ between trusts and Boards.
Nor is the data which is collected comparable across the four nations. In England, the CQC survey is conducted annually with data available by health trust (1). Surveys in Wales, Scotland and Northern Ireland are much more ad hoc and vary in usefulness.
Click here to view the User experience dataLess help than before
Based on the CQC survey, it is clear however is that women in England are reporting that they get less of the help they need than in the years prior to 2019, and less help especially in the period of their postnatal hospital stay.
Figure 1. Did women receive the help they needed during antenatal, labour and birth, and postnatal periods (% Yes, always), England, 2013-2022
Inequalities between trusts
There are also very marked inequalities between Trusts for these indicators.
Figure 2. Did women receive the help they needed during antenatal, labour and birth, and postnatal periods, highest and lowest mean score at Trust level, and difference in mean score, England, 2022
The difference in highest and lowest mean score at trust level is higher for indicators assessing help and support received on the postnatal ward and antenatally. CQC also “benchmarks” trust scores against other trusts to show those that are doing well or less well in comparison with other trusts (see map). Data from maternity surveys from Wales, Scotland and Northern Ireland are not available at health board level, therefore no examination of inequalities between health boards can be done for all four nations.
More and better data
Data on service user experiences should be collected on a regular basis (at least every two years), following a standardised survey to allow for direct comparisons across all four nations, between Health Trusts/Boards and over time to get a good sense of how women regard the maternity care they receive. These surveys, alongside good quality maternity data including data on maternal and neonatal health outcomes and staff experiences, can be used to determine early indicators of problems within maternity care that can be used to highlight potential issues at a national and Trust/Board level - before they get out of hand.
Additionally, there is no widespread data on differences in experience by ethnicity or deprivation. We know that inequalities exist in maternal outcomes in the UK with maternal mortality higher among Black and Asian women compared to white women, and higher among those from more deprived areas than least deprived areas (2). Alongside this, maternity care provided, and women's experiences of maternity care varies, especially by ethnicity and social inequalities, throughout the UK (3). With this in mind, it is imperative that user experience data allows for real examination of inequalities, not just between trusts/boards, but by user background characteristics.
Alongside this, trusts and boards should explore ways of collecting ongoing feedback of user perceptions of service quality that can quickly identify any changes and lead to rapid responses. Currently, trusts in England collect service user experience data via the Friends and Family Test, which tracks the likelihood of service users recommending antenatal, birth and postnatal services. However the response rate for some trusts is low and data is not detailed.
User groups such as Birth Rights (4) and National Maternity Voices (5) can be a valuable channel for learning about user experience and should be considered valuable partners in evaluating service quality.
