A new State of the Nation report released today by the National Maternity and Perinatal Audit (NMPA) found caesarean birth rates increased considerably between 2018/19 and 2023 (unplanned caesarean birth from 15.5% to 23.1%; planned caesarean births from 12.1% to 16.4%). Around 1 in 3 women and birthing people had an induction of labour in 2023, but data showed wide variation in induction rates between different maternity care providers.
The NMPA is the largest quality improvement programme for maternity and neonatal services in the world, providing a unique picture of birth trends and outcomes in England, Scotland and Wales. The report, based on data for 592,594 people who gave birth in Great Britain in 2023, also found:
- In 2023, England and Wales saw the lowest number of births since 1977 and Scotland recorded its lowest ever ‘total fertility rate’.
- Just under half (49.4%) of all births were vaginal births (without the use of instruments) compared with 60.0% in 2018/19.
- Preterm birth rates were similar between countries, but spontaneous preterm births were much higher in Scotland (73.0%) than in England (40.9%) or Wales (46.3%).
- The number of babies born small for their gestational age after 40 weeks fell to 42.6% from 55.4% in 2015/16.
The NMPA, led by the Royal College of Obstetricians and Gynaecologists is calling on national governments to respond to changing maternity trends. Maternity services need an appropriate allocation of resources, such as workforce, finances, bed/cot and obstetric theatre capacity, to optimise women and birthing people’s options for how they choose to give birth.
The NMPA report’s five evidence-based recommendations should now be considered within the Government’s rapid review of maternity and neonatal care, which is committed to establishing one set of clear, cohesive actions for the maternity system.
Professor Asma Khalil, Vice-President of the Royal College of Obstetricians and Gynaecologists, said, “Every woman and birthing person deserves to know that their birth choices and their baby’s outcomes are not affected by where they live. The national and local differences in service provision and clinical practice identified in the NMPA report, which may contribute to unwarranted variation in outcomes, must be acted on.”
“The report also shows major shifts in how women and pregnant people are giving birth, including rising caesarean births and inductions. Governments and NHS leaders must support maternity services to adapt and ensure they have the right staffing, training and facilities to manage increasingly complex births. This is vital to ensuring that all babies and women receive safe, personalised and compassionate care.”
“We support the Health and Social Care Secretary’s recent commitment to a radical new approach to maternity safety, and believe this data and the report’s recommendations will prove invaluable to help support the proposed review.“
Gill Walton, Chief Executive of the Royal College of Midwives, said: “We know that, while the birth rate in the UK has gone down, the complexity and needs of pregnant women have increased exponentially. Every woman and family deserve to leave maternity services safe, happy and healthy, and maternity staff – midwives, maternity support workers, obstetricians and anaesthetists – want to be able to provide them with a safe, positive experience. While this report shows significant changes in mode of birth, we must do more to understand why they are happening, and ensure that women and families receive the most appropriate, safe care.
“Good care shouldn’t be dependent on where you live. The stark variation in outcomes between regions and providers must be addressed and that requires sustained investment in maternity services, including in the bricks and mortar and equipment available. Ensuring we have the right staff, in the right place at the right time with the right education and training is fundamental, and must be a priority for all UK governments.”
Dr Sam Oddie, NNAP Clinical Lead, Royal College of Paediatrics and Child Health said, “The RCPCH welcomes the timely publication of this important report on maternity care. Maternity and neonatal services together form the ‘perinatal team’ and work together to ensure safe care and positive experiences for mothers and babies. Linking high quality, complete maternity data with neonatal data is imperative to support perinatal team collaborations and thus delivering improvements in outcomes for babies.
“The RCPCH in particular welcomes the recommendation to enhance data quality, and is committed, via its National Neonatal Audit Programme (NNAP), to working with the NMPA to improve joint reporting of neonatal outcomes of maternity care.”
ENDS
For media enquiries please contact the RCOG press office on +44 (0)7986 183167 or email pressoffice@rcog.org.uk.
- The full report is available here.
- Full details about all the datasets used for England, Scotland and Wales are included in our methods document here.
- Learn more about the NMPA here.
The National Maternity and Perinatal Audit (NMPA)
The NMPA is a large scale audit of the NHS maternity services across England, Scotland and Wales. Using high-quality data, the audit aims to evaluate a range of care processes and outcomes, in order to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services. The audit produces outputs that can be used by commissioners and providers of maternity services, as well as to support women and birthing people and their families to use the data within their decision making.
The NMPA is led by the RCOG in partnership with the Royal College of Midwives, the Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine, and has a Women and Families Involvement Group. It is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) on behalf of NHS England, the Welsh Government and the Health Department of the Scottish Government.