Maternity in the United Kingdom

Summarize Timeline Fact Check

In March 2023, NHS England published a three year delivery plan which sets out the ways to make maternity and neonatal care safer, more personalised and equitable. The plan has four main focus areas: compassionate care together with women and families; retaining and supporting workforce; a culture of safety, support and learning; and developing standards and structures underpinning improved future care.^[1]

In the United Kingdom, Black women are four times more likely than White women to die during pregnancy, childbirth and in the year following childbirth. Asian women are twice as likely to die as White women. Epilepsy, heart disease and stroke most frequently cause death during pregnancy. Roughly 7 in 100,000 women from White groups die, 12 in 100,000 Asians die, 15 in 100,000 from mixed ethnicity die, roughly 32 in 100,000 black women die during pregnancy, childbirth or in the year after childbirth.^[2]

The Ockenden Review into maternity services at Shrewsbury and Telford Hospital NHS Trust examined 1600 cases over 20 years. There were concerns about 201 deaths, 29 cases of brain injury and 65 babies born with cerebral palsy.^[3] Neonatal deaths in England have dropped by a third and stillbirths by a quarter between 2010 and 2020.^[4] The Healthcare Safety Investigation Branch now investigates all serious maternity incidents - about 1000 each year. Jeremy Hunt argues for a no-fault compensation scheme to replace the expensive and prolonged legal processes currently used. He also suggests that compensation should only take account of costs which would be on top of NHS provision and denounces the principles where the children in rich families get more compensation than those in poor families.^[5]

The continuity of carer maternity model, introduced in 2016, which is aimed at improving care for patients from minority ethnic groups and those with other risk factors was suspended in more than 2/3 of hospital trusts in England in 2022 because of staffing shortages. The number of midwives working in the English NHS had dropped by more than 550 in the year.^[6]

In 2018, 1 out of 3 women gave birth by labour induction.^[7] The procedure is often started without a thorough prior discussion with women or providing adequate information about the associated labour pain and potential risks.^{[citation needed]} Induction of labour is often presented as the preferred option without explaining the alternatives. Providing good quality information in advance and involving women in decision making can improve their experiences.^[4][8]

NHS trusts have for years been benchmarked on their caesarean rates with a target of 20% or less,^[9] but in 2022 these targets were abandoned, following multiple scandals within maternity units, the most prominent at Shrewsbury and Telford Hospital NHS Trust.^[10]

The Midwives Act 1902 established a register of midwives, because of concerns about the large number of maternal and infant deaths. It became an offence to "habitually and for gain, attend women in childbirth otherwise than under the direction of a qualified medical practitioner unless she be certified under this Act".^[11] The register is still maintained by the Nursing and Midwifery Council.