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Maternity audit publishes report to help NHS services deliver improvements

News 9 November 2017

The National Maternity and Perinatal Audit (NMPA) today publishes a major clinical report that identifies areas of good practice and opportunities for improvement in the care of women and babies in maternity services across Britain.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, the NMPA is the largest quality improvement programme for maternity and neonatal services in the world.  It is a landmark 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 (LSHTM).

While the vast majority of women have a safe birth, and despite on-going improvements in the safety of maternity services, findings show that variation exists in a number of clinical processes and outcomes in maternity care. Some of the variation found will be due to differences in data quality, completeness and the risk profile of women being seen in different units.

This data will enable women, clinicians, commissioners and policy makers to evaluate care given locally and nationally and use it to drive further improvements in the quality of maternity services.

The report includes data from 149 of 155 NHS trusts and boards that provide maternity care in England, Scotland and Wales and are based on electronic records of 696,738 births between April 2015 and March 2016*.

The key clinical findings include:

  • Major obstetric haemorrhage, a leading cause of maternal illness, occurs in around 1 in 40 women, but in some units the rate observed was as high as 1 in 20.
  • Third and fourth degree tears, also known as obstetric anal sphincter injuries, occur in around 1 in 30 vaginal births, but in some units it was reported in up to 1 in 15  vaginal births. Severe tears are a major complication of vaginal birth and increase risk of incontinence.
  • Hospitals reported that about 1 in 80 babies require additional support in the minutes after birth, as indicated by a low Apgar score – a measure of the baby’s breathing and circulation – in some units this was as high as 1 in 30.

Other key messages include:

  • Eight out of 10 babies in England receive skin to skin contact within one hour of birth which is known to be important in establishing breastfeeding and bonding. However, there is variation in this measure and in breastfeeding rates.  
  • Of women whose smoking status was recorded at their first antenatal appointment, 14.1% were smoking in England, 15.9% in Scotland and 18.3% in Wales. There is wide variation in the proportion of women who were reported to have stopped smoking during pregnancy.
  • Fewer than half of pregnant women had a body mass index (BMI) within the normal range between 18.5 and 25, and 1 in 5 were obese with a BMI of 30 or over.
  • Over half of all births are to women aged 30 or over and 1 in 7 first births are to women aged 35 or over. The high levels of maternal obesity and increasing maternal age have implications for outcomes and for maternity and neonatal service provision.

The report recommends further improvements in the quality of maternity data so that more outcomes, such as proportion of births without intervention, can be measured accurately.

Dr Matthew Jolly, National Clinical Director for Maternity Review and Women’s Health and speaking on behalf of NHS services in England, said: “The report confirms that, despite the increasing numbers of complex births, the vast majority of women receive high quality care and deliver healthy babies. This comprehensive assessment of performance will act as an important resource and benchmark for maternity services in England as we continue to make maternity services safer and more personal.”

Jan van der Meulen, Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine and Chair of the NMPA Project Team, said: “This national audit, the largest of its kind in the world, makes it possible for the first time to compare the care that maternity units in England, Scotland and Wales provide to 750,000 pregnant women and their babies each year. In some hospitals, the quality of the clinical data needs to be further improved so that the audit can provide an accurate picture of the care that they provide. The audit’s results will be a great help to improve the quality of maternity services.”

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said: “While the UK is a safe place for women giving birth, this report shows variation in care and outcomes for women and babies in maternity services in Britain. While some variation is expected and can drive new improvements, unwarranted or unexplained variation requires investigation. We urge all maternity units to examine their own results and those of their neighbours both to identify role models and to drive quality improvement locally.”

Mandy Forrester, Head of Quality and Standards, Royal College of Midwives, said: “Every day, midwives enter a large amount of electronic information about the women they care for. This report is the first to make use of this data source on a national scale.

More investment in our maternity services, and crucially an investment in more midwives and resources is needed to improve data quality. These initial results, however, identify opportunities for sharing good practice, as well as highlight increasing pressures on the service from demographic changes.”

Professor Anne Greenough, Vice President for Research at the Royal College of Paediatrics and Child Health: “The health and behaviours of mothers during pregnancy can have a real impact on the health of their unborn child. Fewer than half of all mothers have a normal weight at the start of pregnancy – which is associated with greater rates of illness and obesity and a lower life expectancy for their children. There is also wide variation in the proportion of babies receiving breast milk; and it’s well known that breastfeeding has significant health benefits for both mother and baby. It’s critical that public health, maternity and paediatric services work together to ensure that all children get the best start in life.”

[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

Local and national results are available on an interactive website on 9 November: www.maternityaudit.org.uk

*The report includes approximately 92% of all births during the time period.

Modes of birth among women expecting a single, full term baby in the head down position:

o   The proportion of spontaneous vaginal births in England is 65.7%, 65.8% in Scotland and 70.6% in Wales.

o   The proportion of all caesarean sections is 20.7% in England, 19.7% in Scotland, and 15.7% in Wales.

o   The proportion of and instrumental (assisted vaginal) deliveries was broadly similar across the three countries with a national average of 13.6%.

In August 2017, the NMPA published a report providing a snapshot of the availability of services, facilities and staffing in maternity and neonatal care: http://www.maternityaudit.org.uk/Audit/Charting/Organisational

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 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