Maternity postcode lottery revealed in NHS figures

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
Maternity postcode lottery revealed in NHS figuresIn some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“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.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “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.

“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.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”


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