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National audit describes how maternity and neonatal care is provided across England, Scotland and Wales

News 10 August 2017

A new report finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women - but also describes variation in availability of staff, facilities and services

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, the National Maternity and Perinatal Audit (NMPA) is the largest evaluation of NHS maternity and neonatal services undertaken in Britain. It aims to help maternity and neonatal services to identify good practice and areas for improvement in the care of women and babies.

Launched in 2016, the NMPA is a collaboration between the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene & Tropical Medicine.

The first report from the audit provides comprehensive information on how maternity and neonatal care is delivered by the NHS in England, Scotland and Wales. This includes maternity and neonatal care settings, availability of services and facilities, and staffing. 

Further data on the NMPA website will enable healthcare professionals, managers, policy makers and the public to find and compare information from units, such as the number of birth rooms, neonatal cots and  the provision of specialist services for women and babies.*

All 155 NHS trusts and boards providing on-site birth care across England, Scotland and Wales completed the detailed survey. It covered key national policy themes, including enabling choice in where women give birth, encouraging fair provision of specialist services, and providing continuity of carer throughout pregnancy and labour. 

The second report from the audit, due for publication later this year, will draw on the survey’s findings to examine how clinical practices and outcomes for individual mothers and babies vary between units.

Main findings from this first report include:

Birth settings

  • A steady increase in the number of midwife-led units co-located with obstetric units, which has quadrupled in the last decade to 124 - this gives more women a choice about where they can plan to give birth. Two thirds of British obstetric units are co-located with an alongside midwife-led unit (68% in England, 38% in Scotland and 100% in Wales).
  • Only 22% of trusts and boards offer the full range of birth settings (home birth, freestanding midwife-led units, alongside midwife-led units and obstetric units**). These low numbers may be due to geographical factors, such as remote or rural locations. Where feasible, commissioners, trusts and boards should ensure that women have access to all four birth settings either within their own maternity service, or in close collaboration with neighbouring services.

Services

  • Nearly all (97%) trusts and boards use an electronic maternity information system to record the care of women and babies, which helps to ensure safe, transparent and effective care. Only half of trusts report that these records are fully accessible to community midwives, while only a tenth report that women themselves have access to their electronic maternity record.
  • The number of planned postnatal home visits or postnatal clinic appointments for women with an uncomplicated pregnancy and birth ranges from two to six between different maternity services. Services should examine the reasons for this variation and national standards should be developed.
  • Two-thirds (64%) of sites with a neonatal unit provide transitional care - this is where babies who need additional support receive this alongside their mothers, avoiding unnecessary admission to a neonatal unit.  To ensure mothers and babies are kept together, this provision should be expanded.

Staffing

  • 84% of sites which monitor one to one midwifery care during labour report that the vast majority (at least 95%) of women receive this.
  • The vast majority (95%) of trusts and boards have multiprofessional team training for doctors and midwives working together on obstetric emergencies and over 80% have this for fetal monitoring.
  • Only 15% of trusts and boards reported that women see the same midwife for most care contacts in the antenatal, intrapartum and postnatal period, including care in labour from a known midwife.
  • 88% of sites with an obstetric unit reported difficulties in filling obstetric middle grade (registrar) rotas during the previous three months. Medical staffing requirements should be developed to fulfil the needs of a particular unit and aimed at producing the best quality care for all mothers and babies.

With a second survey due for publication in 2019, these results will serve as a baseline at the start of what will likely be a period of considerable change in the maternity and neonatal services following several national reviews currently developing improvements to NHS care for women and babies.

Dr Tina Harris, NMPA senior clinical lead for midwifery, says: “This survey found that there is no such thing as a ‘typical’ maternity unit, and this may be because services are organised in different ways to reflect the needs of the local populations they serve. Nevertheless, all units need to take this opportunity to benchmark their services against others and against national standards where these exist. This will allow consideration of areas for improvement to ensure a high quality service, which enables choice and provides the best possible care for women and their babies.” 

Dr Dharmintra Pasupathy, NMPA senior clinical lead for obstetrics, says: “This is the first report of a wide-ranging evaluation of maternity and neonatal services in England, Wales and Scotland. Reassuringly, it shows an increase in choice for women in terms of where they can plan to give birth, as recommended by national policies. However, there is variation in availability of staff, services and facilities. We hope clinicians, managers and policy makers will use this data to make the best use of the current services available, identify those that do not meet appropriate standards of care, and evaluate where improvements can be made to ensure women and their babies receive world class care.”

Dr Jane Hawdon, NMPA senior clinical lead for neonatology, says: “The 100% participation rate in the audit is a fantastic achievement and demonstrates the clear commitment of maternity and neonatal units in England, Wales and Scotland to improve care provided to mothers and their babies, and the results provide a rich overview of current services available. Maternity and neonatal care are tightly intertwined and it is only by working together that we will achieve the best care for women and their babies. Units need to consider the needs of women, babies and families together, and this report emphasises this collective approach.”

[ENDS]

Note to Editors 

For media enquiries, including requests for copies of the report, contact the RCOG press office on 020 7045 6773 or email pressoffice@rcog.org.uk

* The website will be available here: www.maternityaudit.org.uk  
More information will be added to the website as the audit progresses.

** An alongside midwife-led unit is a maternity unit where midwives have primary responsibility for care during labour in women at low risk of complications and which is located on the same site as an obstetric unit so it has access to the same medical facilities if needed.

A freestanding midwife-led unit is a maternity unit where midwives have primary responsibility for care during labour in women at low risk of complications and which is not located on the same site as an obstetric unit. If complications develop, women will be transferred to an obstetric unit by ambulance.

An obstetric unit is a maternity unit where care is provided by a team of midwives and doctors to women at low and at higher risk of complications. Midwives have primary responsibility for providing care in labour and afterwards to women at low risk of complications, while obstetricians have primary responsibility for women who are at increased risk of, or who develop complications. Obstetric, neonatal and medical services are available on site.

About the NMPA 
The NMPA is a unique collaboration and audit that aims to produce high-quality information about NHS maternity and neonatal services which can be used by providers, commissioners and users of the services to benchmark against national standards and recommendations where these exist, and to identify good practice and areas for improvement in the care of women and babies.
The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, the Welsh Government and the Health Department of the Scottish Government. It is being carried out by the Lindsay Stewart Centre for Audit and Clinical Informatics at the Royal College of Obstetrician and Gynaecologists (RCOG) in partnership with the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene and Tropical Medicine. For more information about the National Maternal and Perinatal Audit, visit: www.maternityaudit.org.uk

About the Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. www.rcog.org.uk

About the Royal College of Midwives 
The Royal College of Midwives (RCM) is the only UK professional organisation and trade union dedicated to serving midwifery and the whole midwifery team. The RCM has a vital role in disseminating information about professional midwifery practice, and in ensuring that there is a recognised UK-wide platform for sharing good practice. This includes professional and clinical guidance and information, online resources, reports on service provision, and conferences and events. www.rcm.org.uk 

About the Royal College of Paediatrics and Child Health
The mission of the Royal College of Paediatrics and Child Health (RCPCH) is to transform child health through knowledge, innovation and expertise. The RCPCH aims to improve outcomes through research, standards, quality improvement and policy, in the UK and globally, and to ensure the voice of children, young people and families in its programmes. The RCPCH is responsible for the postgraduate training of paediatricians in the UK and provides access to multidisciplinary educational programmes. www.rcpch.ac.uk 

About the London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with more than 4,000 students and 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, is among the world's leading schools in public and global health, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. www.lshtm.ac.uk

About HQIP, the National Clinical Audit Programme and how it is funded
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk