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'No such thing as typical maternity ward' in mixed audit results

Midwifery Review RCM
A ‘worryingly’ low number of mothers are seeing the same midwife in most appointments across their perinatal period

A ‘worryingly’ low number of mothers are seeing the same midwife in most appointments across their perinatal period, according to an audit on maternity in the UK.

The National Maternal and Perinatal Audit (NMPA) published their first report on 10 August to provide information on how maternity and neonatal care is delivered by the NHS in England, Scotland and Wales, including maternity and neonatal care settings, availability of services and facilities, and staffing.

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It showed that 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, sparking concern from the Royal College of Midwives (RCM).

RCM head of quality and standards Mandy Forester said: ‘It is worrying that so few women are seeing the same midwife or group of midwives. Continuity of carer is crucial to ensuring safe, high quality care. Another concern is that so many women cannot get access to their electronic pregnancy records; this disempowers women and needs urgent attention.’

While 97% of trusts said they use an electronic maternity information system to record the care of women and babies, only half of trusts have made this resource accessible to community midwives, and only a tenth have made it available to mothers.

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At least 95% of mothers receive one-to-one midwifery care during labour at 84% of the sites that observe this practice and the number of midwife-led units co-located with obstetric units has quadrupled in the last decade to 124, giving more women a choice about where they can plan to give birth.

‘We have concerns about what services maybe being affected to ensure one-to-one care actually happens, as this could potentially be at the expense of midwives being pulled out of community services,’ said Ms Forester. ‘There is much to be optimistic about, but this report also throws up some issues of real concern.’

However, only 22% of trusts offer the full range of birth settings, possibly due to geographical factors, such as remote or rural location.

‘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,’ said NMPA senior clinical lead Dr Tina Harris.

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‘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.’

Other problems highlighted by the audit, included troubles in filling obstetric middle grade rotas at 88% of trusts, and a wide variation in average number of postnatal visits with trusts reporting anywhere between two and six visits per mother.