Pressures in maternity services: what the maternity statistics tell us

on 01 December 2021

The RCM’s Director of Professional Midwifery, Dr Mary Ross-Davie, and Professional Adviser for Quality & Standards, Lia Brigante, identify longer ante- and post-partum stays as a possible root of additional pressure on maternity services

Last week saw the publication of the annual NHS Maternity Statistics by NHS Digital which highlighted the continuing trend of falling birth rates, and a significant increase in caesarean births and inductions of labour.

The data highlight significant changes in the process and outcomes of birth. Induction of labour has become much more common – rising from 21% in 2010-11 to 34.4% of births last year. Similarly, elective caesarean birth has increased to 14.6% from 10.1% in 2010-11 and emergency caesareans have followed a similar pattern, increasing over the last decade from 14.8% to 18.9% of births.

Such changes have a significant knock-on effect in terms of workload for maternity services. These figures break down the length of antenatal stay for women in spontaneous labour, compared to women being induced. Most women in spontaneous labour (71.4%) are admitted to hospital on the same day they give birth, for women who are being induced this is only true for 12.8%. Around a quarter will be in for two days prior to birth and just over one in 10 for three days. This means that 22,000 women were in hospital for two days before giving birth last year and 7,500 for three days while being induced. This helps to explain why maternity units are feeling so busy, even though the number of births has fallen.

Induction of labour is also linked to higher rates of postpartum haemorrhage (Dahlen et al, 2021, NICE 2021a) and caesarean births are linked with higher rates of a range of morbidities and a longer postnatal stay (NICE, 2021b); so these data again help to explain the pressures in postnatal wards.

These statistics highlight again the differences between groups of women giving birth in England last year. Asian women are most likely to have a caesarean birth (39.8% overall, which is made up of 25.5% emergency and 14.3% elective). Black women have a caesarean birth rate of 36.1%, while the figure for white women is 32.7%. Women living in the least deprived areas of England are the most likely to have an elective caesarean, with a rate of 16.7% compared to women in the most deprived areas (12.8%). Women over the age of 40 also have a much higher rate of caesarean birth.

We know the reasons for these differences are complex and it is vital that every Trust across England spends time looking in detail at their own data and the differences between groups of women they care for and how their figures compare to other Trusts. Variation in care practices is likely to be one factor in these figures and we should all be continuing to work towards ensuring that all women and people in our care can expect the same high quality care, whatever their background and whatever hospital they give birth in. Midwifery leadership plays an important part in ensuring that care is evidence based and is in line with current UK guidance, such as NICE, RCM Bluetop guidance and RCOG. The importance of developing robust local systems for multi-professional development and updating of guidelines is key, along with robust mechanisms of audit to identify whether guidelines are being implemented.