The latest Care Quality Commission (CQC) maternity survey has just been published and it’s findings are interesting but concerning.
It found that “at a national level the 2022 maternity survey shows that people’s experiences of care have deteriorated in the last 5 years.”
Of the 26 evaluation questions used in the survey:
- 21 showed a significant downward trend
- 4 showed no change and
- 1 showed a significant upward trend
You can read more about the maternity survey here but here are the main antenatal points for me…
Availability of staff
- 63% of labouring women were able to get a member of staff to help them (this has dropped from 72% in 2019)
- 8% of women said they were left alone in the later stages of labour
This is worrying as it could impact how looked after and reassured a woman feels, not to mention how safe it is. So, what can you do? It may help to prepare well so you can work with your contractions and know what you can do to help manage your labour but that may only do so much. Hiring a doula can give you ongoing support as well as additional help to speak to your midwife. Don’t be afraid to speak up, to ask questions, to ask for more support.
Concerns taken seriously during labour
- 23% of women said their concerns were not taken seriously during labour and birth
Unfortunately I know that women can be dismissed about the pain they are experiencing and how far into labour they are – I have heard this throughout my 20 year career, I have seen it as a birth doula and I have experienced it twice as a labouring woman. So, what can you do? Stay calm and focused because panic won’t help you to be heard and listened to. Your birth partner can communicate the concerns clearly, if you still feel ignored you can ask to speak to another midwife.
Start of labour
- 18% of women said they were not given appropriate advice and support at the start of their labour
Know more about the beginning of labour, what it can be like and how long it can last. Ring the maternity unit, use your local assessment unit for reassurance and it may help to be prepared to labour at home. Birth doulas can help with early labour, as they can visit you at home before you are ready for midwifery care.
Type of birth
Spontaneous labour is still most common way for labour to start but the report highlighted that it has decreased over time
- 47% of women said labour was spontaneous (66% in 2012)
- 20% of women had a caesarean (12% in 2012)
- 33% of women were induced (22% in 2012)
The NICE Guidelines “advises that women with uncomplicated pregnancies should be given every opportunity to go into spontaneous labour. Induction should only be offered to prevent prolonged pregnancy or if there is a risk to the baby or the mother’s health.” This is difficult when induction has become standard at 41 weeks, which could account for the increase. Women need to know they have options.
Unassisted vaginal births have also declined since 2018
- Only 51% of women gave birth without forceps or ventouse (62% in 2018) and 27% of these women still gave birth on a bed with stirrups
Where do I start with this? Women need to be encouraged and supported to move and be more upright on and off the bed – so many mums tell me they wanted to move, to be up but they felt unable at the end and it’s difficult to argue if you are tired, in pain and overwhelmed by it all.
But women should have a voice and it is okay to say what you need and to ask for help to find positions that work better for you. I know it’s not that simple though.
Birthing positions
- 62% of women gave birth lying down (39% in stirrups / 23% lying flat)
- 15% of women gave birth in upright positions
It comes as no surprise to me that “Women who did not use stirrups when their baby was born reported better than average experiences for questions on information provision in hospital and involvement during labour. Conversely, women who gave birth lying with their legs in stirrups when their baby was born reported worse than average experiences for the same questions.”
These statistics are shocking – women need to be encouraged and supported to use different positions in labour and for birth. What can you do? Good birth preparation really can make a difference so you can have a voice and ask for support so you can do what works for you.
Place of birth choice
- 19% of women were not offered any choices about where to have their baby
Ask questions, research local options including a homebirth, join the local Maternity Voices Facebook groups – you don’t have to make a decision at the beginning of your pregnancy.
Mental health support
- 71% of women were asked about their mental health during their antenatal appointments (67% in 2019)
- 85% of women said they were given enough support for their mental health during their pregnancy (83% in 2021)
This is positive and I really hope this continues to improve and women are encouraged to be open and to have more support.
Communication
- 59% of women were given the information/explanations they needed (66% in 2017)
So 40% of women are lacking the information they need, which definitely needs to improve. What can you do? Ask questions, know your options and talk to me about your birth preparation for more information and support, as well as reassurance.
The report reinforces that maternity services are struggling – it is stretched, midwives are tired and the system is struggling to cope. It is clear that improvements but does there also need to be change in how we prepare for labour and birth?
Birth preparation needs to go beyond information, it needs to give women a voice so they can gather knowledge, know options, know where the challenges can be, plan realistically, ask questions and say what they need.
My approach is about preparation beyond the ideal birth – it is important to know more about the challenges and the options so you aren’t left blindsided and unsupported.
It’s also important to feedback your experience to your maternity unit – it doesn’t have to as a complaint but just to document how something could have been different. Nothing changes unless maternity units know.
Just message me below to talk about preparing for the birth of your baby.
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Copyright: Janine Smith