Having a Baby in Scotland 2015: Maternity Care Survey

Executive Summary

Introduction

This report presents the national findings of the 2015 Scottish Maternity Care Survey, describing the experiences of more than 2,000 women who gave birth in Scotland during February and March 2015.

The survey provides high quality and comprehensive information on women's experiences of maternity care in 2015 and repeats the survey undertaken in 2013. The results provide a benchmark for improvement in maternity service and will inform the current review of maternity services in Scotland (www.gov.scot/Topics/People/Young-People/child-maternal-health/neonatal-maternity-review).

For the first time the 'free text' comments women made in answer to the question, 'If there is anything else you would like to tell us about your care …', asked at each stage of the questionnaire, have been analysed and included in the main report. Overall 1,244 women made comments equating to just over 61% of the total sample. These comments provide additional insights, and increased understanding of the questionnaire results, highlighting issues of importance to women and areas where care fell short of women's expectations.

Main results

The survey reports a very positive picture of women's experience of maternity care overall with very few differences in the findings from 2013. In most instances women report experiencing excellent care from staff who are listening to them and sensitive to their needs. However, an aim of this survey is to identify areas where service improvement is required; therefore it is important to examine the more negative aspects of care that were experienced by a minority of women.

Overall women are accessing maternity care earlier in their pregnancy; more women are contacting a midwife directly when they think they are pregnant and having their antenatal booking assessment earlier than in 2013. Women know how to contact a midwife and when they do so they usually get the help that they need. Although most women said that they were involved enough in antenatal care decisions, relatively few said that they had choices about where their antenatal care would take place, and only one in four had a choice of place of birth.

Women's comments indicate how vitally important it is for them to have the opportunity to develop relationships with staff through continuity of care. This relates not only to midwives but also to medical staff, and this was particularly important for women with more complex needs. High quality research indicates that continuity of care results in improved clinical and psychosocial outcomes for mothers and babies. The survey found that about two thirds of women in this survey said that they saw the same midwife all or most of the time for their antenatal care (an increase from 2013), only around half of women received continuity of postnatal care.

The questionnaire asked whether women felt that they received appropriate advice and support when they contacted a midwife or the hospital when they thought labour had started. The large majority of women said that they did, however a number of women commented on their negative experiences of contacting the maternity unit or hospital triage area. Some described encountering staff who were dismissive or patronising and who did not appear to take them seriously. This contrasted strongly with women's very positive accounts of the supportive care they received during labour and birth. Many women commented to express the considerable trust that they had in the staff who cared for them during their labour, including members of the multi-professional team, and expressed how this had enhanced their birth experience. However, the inclusion of two new questions relating to labour pain management revealed that only two thirds of women felt they were definitely given enough information about pain relief and 59% said that they always had enough help to cope with their pain during labour.

Postnatal care both in hospital and at home was rated less highly than other stages. With findings very similar to those reported in 2013, a significant minority of women did not feel that they always received the information and advice that they needed and that advice, in particular relating to infant feeding, was often inconsistent. Around one third of women said that they were not always treated with kindness and understanding. Asked about care in the six weeks following birth, just over half of women felt that they had enough information about their own physical recovery or potential emotional changes. Women's comments indicated that they appreciated compassionate and sensitive care in this period, and a hospital environment which afforded them and their babies' sufficient access to clinical care, food, rest and support. They reported disappointment with over-stretched staff teams, lack of care and attention, being left alone and separated from the support of family, and care which did not meet their physical and emotional needs in the immediate aftermath of the birth.

Key points

Care during pregnancy

• 61% of women rated their antenatal care as excellent.
• 93% of women had their antenatal booking appointment by 12 weeks, 61% before 10 weeks.
• 99% of women had a number to contact their midwife or midwifery team, 84% who did so always got the help that they needed.
• 66% of women saw the same midwife all or most of the time for their antenatal checks, an increase from 2013.
• 15% of women saw a health visitor during their pregnancy and most said this was useful. 50% did not and said they did not want this.
• 20% of women were offered a choice of where their antenatal checks would take place.
• 24% were not offered any choice about place of birth and only 56% said that they definitely had enough information to help them make this choice.
• Over 80% of women said that they were listened to, had time to ask questions and were spoken to in a way that they could understand.
• Women's comments highlighted the importance of continuity of care and the opportunity to build relationships with their care providers. This was very important for women with more complex pregnancies involving the multi-professional team. Seeing different staff was tiring and frustrating for women and they associated this with poorer communication and inconsistent information and advice.

Care during labour and birth

• 74% of women rated the care they received in labour as excellent.
• 66% of women said that during their pregnancy they were given enough information about pain relief for labour and birth.
• 59% said they always had enough help to enable them to cope with their pain during labour
• 73% of women were able to move around and choose a position that made them most comfortable during labour, only 32% give birth in an upright position.
• 84% of women said that if they raised concerns during labour these were always taken seriously and 77% of women who called for assistance during labour said that they always received it within a reasonable time.
• 83% of women said that all staff introduced themselves.
• 77% of women said that they were always involved enough in decisions about their care and 95% that their birth partner was always involved in their care as much as they wanted.
• 92% of women said that they had a period of skin to skin contact with their baby following birth.
• Women's comments indicated that they valued the support of skilled, supportive and confident staff who listened to their concerns, took time to give them explanations and involved them and their birth companions in decisions. Women were disappointed by staff who were dismissive of their concerns, in particular relating to uncertainty about whether labour had started.

Postnatal care in hospital

• 54% of women rated their postnatal stay in hospital as excellent.
• 40% of women only sometimes or did not receive the information or explanations that they needed.
• 31% said they were not always treated with kindness and understanding.
• 58% of women said their partner or other person close to them could stay as much as they wanted.
• 65% received relevant information and 62% active help and encouragement about infant feeding.
• 55% said that they always received consistent advice about feeding their baby.
• Women's comments on care in hospital highlighted the central importance of supportive compassionate care from midwives as well as practical help and assistance with self-care and infant feeding. Where this was present women's experience was enhanced, in its absence mothers felt vulnerable and anxious.

Postnatal care at home

• 58% rated the care they received in the community after the birth as excellent.
• 99% of women received a visit from a midwife at home 50% saw a midwife three or four times.
• 51% of women saw the same midwife all or most of the time.
• 98% of women had a telephone number to contact a midwife or midwifery team, 85% who did so said that they always got the help that they needed.
• 81% said midwives always took their personal circumstances into account when giving advice.
• 74% received help and advice about their baby's progress.
• 56% were given enough information about their own physical recovery and 57% were given enough information about emotional changes that they might experience.
• As with antenatal care, comments highlighted the importance of continuity of care and the opportunity to develop relationships; this was associated with consistent advice and support which was highly valued by women. Seeing different midwives was frustrating and stressful for women. Many women felt uninformed about their own health and recovery from birth.