Antenatal delays and patchy childbirth care

Jayne Howarth and Stacey Collins
Massive differences in the quality of maternity services in different English hospitals were revealed yesterday.

The figures showed some hospitals struggling to give women an antenatal appointment within the first three months of pregnancy.

But the extent of the differences
around Britain puzzled experts.

The Hospital Episodes Statistics maternity report 2009-10, from the NHS Information Centre, shows that there are vast differences in the rates of caesareans, episiotomies and even antenatal assessments across the UK.

Royal College of Midwives general secretary Cathy Warwick said the findings might reflect midwife shortages in some areas.

She said: "Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

"The variation on the first antenatal booking is astonishing and those on caesarean section rates - already widely known - are worrying in their persistence at such a level.

"These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a 'national' health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old
good luck."

But Professor Alison Macfarlane, professor of perinatal health at City University London, said it was "almost impossible" to interpret the statistics.

She said: "The national figures include some reassuring information, notably the overall percentage of caesareans has remained relatively steady, which is promising in the light of concerns about rising rates in recent years."

The report shows that:

• The percentage of women seen for their first antenatal assessment within the recommended first 12 weeks of pregnancy stood at 89.6 per cent at Royal Cornwall Hospitals NHS Trust, 11 times higher than at Walsall Hospital NHS Trust, where it was 8.3 per cent. The national average is 63 per cent.

• The percentage of women who underwent a caesarean section at Imperial College Healthcare NHS Trust in London was 31.4 per cent, almost twice as high as that at Shrewsbury and Telford Hospital NHS Trust in Shropshire, where 15.8 per cent of women gave birth that way. The national average is 24.8 per cent.

• At the George Eliot Hospital NHS Trust in Nuneaton, 18.4 per cent of women who had spontaneous deliveries had to have an episiotomy, compared with 3.4 per cent at Barnsley Hospital NHS Foundation Trust and a national average of 8.3 per cent.

Tim Straughan, chief executive of The NHS Information Centre, said there were also striking differences between neighbouring trusts.

The percentage of women who had their first antenatal appointment within the recommended first 12 weeks of pregnancy at Rotherham NHS Foundation Trust was 87.6 per cent, compared with just 17.2 per cent at Barnsley Hospital NHS Trust.

Just over 30 per cent off women underwent caesarean sections at Hereford Hospitals NHS Trust, compared with 15.8 per cent at Shrewsbury and Telford.

"The purpose of the report is to provide national and local comparative data about maternity services to help trusts examine their practices and how they are changing over time,” said Mr Straughan.

“The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions. In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries."

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