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What does the CQC Maternity Survey mean for you?

In a nutshell, the latest 2023 CQC National Maternity Survey probably didn't shock or surprise maternity care bosses as it landed in their inboxes. It follows the wider narrative hitting headlines right now, showcasing the huge workforce crisis and the heap of pressure our NHS is under.

"The trend analysis carried out this year reveals a concerning decline over time, particularly in relation to accessing information and support and getting help when it was most needed." Victoria Vallance, CQC Director of Secondary and Specialist Care

In a post-pandemic world we talk about how we couldn't have got through the darkest days of Covid lockdowns without the unwavering dedication of the health care professionals (HCPs) and senior management who reviewed and adapted policies overnight, created new styles of working and upheld the NHS written constitution in admirable spirit.

It is unsurprising that there is a markedly downward trend in 10 crucial areas over the last five years. I don't believe a blame game at a micro-political level is productive, the report highlights much bigger topics which the doula community and some midwife commentators have been discussing openly for quite some time. I've broken them down into antenatal education, labour and birth and postnatal support.

Antenatal care

The proportion of women and birthing people being given the help they need when contacting antenatal midwives has dropped to 69% (a 5% decrease in 5 years).

Only 69% of people definitely have confidence and trust in the staff delivering antenatal care

Continuity of care was outlined as the blue print for the future of services back in 2017 as part of the Better Births report as part of the National Maternity Review. To now be in a position where pregnant women are less likely to be able to contact or have an appointment with a named midwife, goes a long way to explaining why their needs are not being met. Building a strong relationship built on trust and mutual understanding is an undisputed basic requirement for most people to reach peak communication and truly understand the needs of the pregnant woman.

This lack of confidence and trust is also understandable when we see the high numbers of women discussing being booked for countless growth scans without full understanding as to the reasons why so they can make an informed choice whether or not to proceed with having them. For those who are having them, the increased number of inductions and subsequent c-sections forms a narrative demonstrating the cascade of interventions being initiated when pregnancy is barely into the second trimester.

Labour and Birth

Alarmingly, women and other pregnant people were less likely to say they were ‘always’ able to get a member of staff to help them when they needed attention during labour and birth; 63% compared with 65% in 2021 and 72% in 2019. This is translating to pain relief being withheld or not being made available upon request, especially highlighted for birthing people identifying as black or from an ethnic minority Women's birth preferences should be discussed so they can make informed choices for how they would like their care to be upheld during birth, but as shown already, if they are not being given the help they need during the antenatal period to make informed choices - they're entering the birth space on the back foot.

One of the greatest areas for concern is that

Only 59% of women and other pregnant people were always given the information and explanations they needed during their care in hospital

down from 66% in 2017. Without information and explanation, informed decisions cannot be made. NICE guidelines state

"People have the right to be able to make informed decisions about their care"

To make an informed decision, you must be presented with all information - without this choices are at risk of being emotionally driven or through coercion.

Postnatal period

The report finds that in terms of postnatal care,

70% were 'always' given the help they needed when contacting a midwifery or health visiting team'

down from 73% in 2021 and 79% in 2019. The fourth trimester is such a vital time in a new family's life.

I do feel it is really important to look at the positives; one of which is that in terms of postnatal care, the vast majority said a midwife or health visitor asked them about their mental health (96% compared with 95% in 2021 and 2019).

In summary

Most excellent Midwives and HCPs would probably agree that they never entered their profession wanting to experience the realities behind these statistics. They are doing the very best they can with the bare minimum resources and time available.

For every 30 trainee midwives, 29 leave the profession. That is why I urge people to follow #MarchwithMidwives and hear the plight of those on the front line - it really is a campaign for all.

The report demonstrates the reality that we are a long way off embedding the continuity of care model which has been proven as a requirement. Women and birthing people need to feel confident, heard and listened to at all stages of their journey through the maternity care system.


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