CQC Maternity Survey

The Care Quality Commission (CQC) has published the results of its 2017 Survey of Women’s Experiences in Maternity Care.

The results of the survey have been reported to demonstrate that of the 18,426 women who gave birth in February 2017 across 130 NHS Trusts and responded to the survey, overall, they had a more positive experience of antenatal, intrapartum and postnatal care than the women surveyed in 2015. However, whilst statistically the survey can be said to report minor improvements in choice, communication and continuity of care, it is limited in scope by its low response rate (37%) and specifically excluded women whose maternity experience ended in stillbirth, neonatal death or with mother or baby still in hospital at the time of the survey. Amongst those who were included and responded, nearly 23% experienced being left unattended by midwives or doctors in circumstances which worried them during labour, after the birth and, in 2% of those cases, during the birth itself.

In response to the CQC’s Maternity Services Survey, Elizabeth Duff, Senior Policy Advisor of the National Childbirth Trust (NCT) welcomed the clarity and improvements that the Better Births [link to our previous mentions here?] recommendations were bringing about in maternity services. However, she called for a lot more to be done to ensure that all women receive the quality of care that they need. In particular, she expressed “great concern that 23% of women are left alone during the birth of their baby which can be a very frightening and dangerous experience. This reinforces the fact that staffing levels are low and midwives are being stretched to the limit, so we continue to call on the Government to address this midwife shortage.”

The NCT’s own research, ‘Support Overdue: Women’s Experiences of Maternity Care 2017’, revealed last year that 50% of women experienced at least one ‘red flag’ event during labour. The National Institute for Health and Care Excellence (NICE) guidelines set out ‘flag events’ which warn nurses in charge of shifts that staffing levels are unsafe and must be addressed urgently to ensure that patients’ needs can be met. In a maternity setting, red flag events include having to wait more than 30 minutes for pain relief or over an hour to be stitched after the birth.

Women in the UK have a right to NHS care from a midwife or doctor during labour, birth and the immediate postnatal period. Where staffing levels are low or at times of high activity on a maternity ward, women and their babies are put at serious risk when they are left unattended at this critical time.

Boyes Turner’s cerebral palsy experts are currently acting for several severely injured clients whose injury would have been avoided if the mother had been properly and continuously cared for during labour and delivery.

In one recent case a defendant hospital has admitted liability for the child’s, whole body cerebral palsy and severe spastic diplegia, caused by hypoxia (oxygen deprivation to the baby) during his mother’s labour. His mother was admitted to hospital in labour with pain and symptoms suggestive of a placental abruption. After misinterpreting the CTG (fetal heart monitor) reading as normal, the midwife left the mother unattended and unmonitored, and when her condition deteriorated it took her husband two attempts to persuade the midwife to come and look at his wife. When the midwife attended much later, the fetal heart could not be detected and when a caesarean section was finally carried out, the mother’s uterine scar from her previous caesarean was found to have ruptured.

In another case, our client suffered severe birth asphyxia when her mother was left unattended and unmonitored in labour, having been refused epidural pain relief as there was no midwife available to monitor her, after a delayed admission CTG trace had revealed that the baby’s heart rate was tachycardic (abnormally fast). When the mother started to push, her husband had to find a midwife to attend his wife. On setting up another CTG the midwife discovered that the baby’s heart rate now revealed reduced beat to beat variability and late variable decelerations – both serious indications that the baby was being deprived of oxygen. Instead of calling for obstetric review, despite the monitor showing clear evidence of fetal distress, the mother was made to deliver the baby vaginally, a process which delayed the birth by a further two hours.

Boyes Turner welcome all genuine improvements in maternity care but, sadly, the results of the CQC’s 2017 Maternity Care Survey remain a cause for concern.