Many women left alone during labourHealthcare Commission report shows trusts differ

27 November 2007

One in four women is left alone during labour or shortly after birth despite being worried, according to a report out today.

The study, from the Healthcare Commission, warned that midwives may be failing to adequately reassure women when they leave the room.

Official guidelines from the National Institute for Health and Clinical Excellence (Nice) state that women in labour 'should receive supportive one-to-one care'.

Trusts varied

It continues: 'A woman in established labour should not be left on her own except for short periods or at the woman's request.'

Today's report into maternity services found widespread variation between NHS trusts, with 9% of women at one trust saying they were left alone, while the figure was 33% at another trust.

In 18 out of the 148 trusts, more than 20% of women said they were left alone during labour at a time that worried them.

Food quality concerns

A total of 26,000 women who had a baby in January or February this year were surveyed for the study, making it the largest ever poll of women giving birth in England.

There were positive responses to the quality of care overall, with 89% of women saying it was excellent, very good or good during pregnancy; 90% saying it was excellent, very good or good during labour and birth; and 80% saying so for the time after birth.

However, there were several areas of concern, including the ability of staff to communicate, aspects of postnatal care, the quality of food and standards of cleanliness.

Women left alone

The study found a higher proportion of first-time mothers had been left alone during labour and/or shortly after the birth (28%) compared with women who had previously had a baby (25%).

Only 20% of women said they had one midwife who looked after them during labour and birth, while 43% said three or more midwives cared for them.

Women were more likely to have been looked after by one midwife if they had a shorter labour (less than eight hours) and/or had a normal birth.

20%

Women who had one midwife throughout labour

More than half gave birth either lying down (30%) or lying with their legs supported in stirrups (27%).

This is despite Nice guidance recommending that women be discouraged from having their baby in this position during a normal birth.

Stirrups

At one trust - Barts and the London - 44% of women used stirrups to give birth, followed closely by Basildon and Thurrock University Hospitals NHS Foundation Trust, where 43% of women used them.

Overall, only 13% of women said forceps or a vacuum cap were used during delivery - valid medical reasons for women giving birth in a lying position.

The government has pledged that all women should be supported by a named midwife throughout their pregnancy.

Today's survey found that only 22% of women had previously met any of the staff that looked after them during labour and birth.

Most women (68%) said they 'definitely' had confidence and trust in the staff caring for them while 27% said they had 'to some extent'.

Breastfeeding support

Women were also asked about the advice and support they had received from midwives and other carers in relation to breastfeeding their baby or using a bottle.

Almost a quarter (23%) said they had not received consistent advice, 22% got no practical help and 22% had no active support and encouragement.

The Healthcare Commission will publish its full review of maternity care early next year.

Government strategy

Dr Gwyneth Lewis, from the Department of Health, said: 'This survey provides NHS maternity services with a clear indication of satisfaction levels and will help them focus on where they need to improve.

'It is encouraging that the vast majority of respondents - 90% - reported their care during labour and birth as being excellent, very good or good.

'We want to see these positive experiences replicated throughout the entire process - during pregnancy, labour, birth and post-natally.

'That is why we are working with the NHS to implement Maternity Matters, our strategy for providing safe, high quality maternity care for every woman.'

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