Latest national maternity audit highlights concerns over midwives shortages and consistency of care

The first report from the National Maternity and Perinatal Audit (NMPA) provides comprehensive information on how maternity and neonatal care is delivered by the NHS in England, Scotland and Wales. Findings highlight difficulties with staffing and a variation across maternity units in the provision of postnatal care. The audit recommends the development of national standards and medical staffing requirements.

The National Maternity and Perinatal Audit (NMPA) is a collaboration between the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene & Tropical Medicine. 

The audit found that variation across maternity units resulted in the number of planned postnatal appointments for women, either at home or in clinic, ranging between two to six between different maternity services. In addition, only 15% of trusts and board reported that women see the same midwife for more care contacts in the antenatal, antenatal, intrapartum and postnatal period, and 88% of sites with an obstetric unit report difficulties in filling obstetric middle grade (registrar) rota during the previous three months.

Dr Jane Hawdon, NMPA Senior Clinical Lead for Neonatology and member of the RCPCH, was involved in the audit. She said: “The 100% participation rate in the audit is a fantastic achievement and demonstrates the clear commitment of maternity and neonatal units in England, Wales and Scotland to improve care provided to mothers and their babies, and the results provide a rich overview of current services available. Maternity and neonatal care are tightly intertwined and it is only by working together that we will achieve the best care for women and their babies. Units need to consider the needs of women, babies and families together, and this report emphasises this collective approach.”

Dr Tina Harris, NMPA Senior Clinical Lead for Midwifery, said: “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. 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.” 

Commenting on the audit, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “The difficulties in securing staffing in obstetric units is particularly worrying. Moving forward, it is anticipated that rota gaps will persist and worsen in most units. The pressures on maternity services are growing, which could compromise the experience for women and their families,” she said.

All 155 NHS trust and boards providing on-site birth care across England, Scotland and Wales submitted information to the audit, and findings will serve as a baseline for what will likely be a period of considerable change in the maternity and neonatal services following several national reviews currently developing improvements to NHS care for women and babies.