No. 31 Session 2002-03 17 June 2003
Provision of Maternity Services - Report published
Julia Drown MP, Chair of the Maternity Services Sub-committee said:
Our inquiry sets out to see how maternity services have changed over the last ten years in response to the Government report Changing Childbirth which hoped to create women-centred high quality services across the country. This first stage of our inquiry concentrated on regional variations in services across the country staffing, training and information issues in maternity services. In order to gain a 'snapshot' of the provision of maternity services, and to hear from those most closely involved, the Sub-committee took evidence from health professionals and user representatives from maternity units in each of the eight NHS regions.
Although we found some excellent examples of maternity services we were disappointed that much of what was expected by the Government ten years ago has not been created consistently across the country.
We are confident that there is excellent work going on in all the maternity units we heard from but it is clear from our inquiry that more needs to be done to address the huge variation in practice across the country - for example, to explain to the public why the caesarean section rate at the Rosie Hospital, Cambridge compared with that of St Mary's Hospital, Manchester means that there are 300 more women cared for by the Rosie Hospital, who are having major surgery each year. In Manchester these women might have had a normal birth. The rate is rising overall (it now stands at over 22%) which means that there are many women unnecessarily undergoing major operations. Caesareans carry a 3 fold risk of women dying in labour and are more likely to lead to infections and future infertility problems as well as needing a longer recovery time than normal births.
We were concerned to hear that basic good practice guidelines for reducing caesareans are not always put into place - for example mothers of breech babies are not offered a technique to try and turn the baby around. This technique is successful in half of the cases but was only offered to one third of women with breech babies. Keeping to basic good practice guidelines like these should reduce unnecessary caesareans by at least 5%.
The costs to the NHS of this are significant - a caesarean was costed at £760 more than a normal birth in 1997. So across the NHS this adds up to a substantial sum with every 1% rise in the national caesarean section rate costing the NHS £5 million. The Committee's view is that given the NHS's response to other treatment choices, elective caesareans made as a 'lifestyle choice' would be difficult to support in the NHS, and that caesarean sections should only by done when medically or psychologically necessary.
We heard from many units about problems over staffing levels - in some delivery suites midwives had to care for several women at a time and levels of on-site consultant cover were low. Midwives are having to spend more time supporting interventions such as caesarean sections which reduces their time available to support normal birth. This can create a downward spiral whereby the lack of support for normal birth means more unnecessary interventions for mothers. We identified a loss of confidence by staff and parents in normal birth which is a serious concern - this confidence needs to be built back up by strengthening the importance of normal birth in training of all staff. Making the midwife the first point of contact for a discussion on maternity choices rather than the GP is one of our recommendations to help this.
Staffing shortages can be self-perpetuating in that they lead to extra stress on staff and further problems in recruitment and retention, so we recommend a review and a renewal of government efforts to recruit more midwives in particular - and to get more who are registered back into work.
We were amazed at the lack of good information available to maternity units due partly to inadequate systems but also due to a lack of support for systems and inconsistent data definitions - for example over what is meant by a 'normal' birth. This is despite government attempts to make such data consistent. At its worst we heard from maternity unit staff who input data to a computer knowing they had no way of getting information out at the end of it.
Notes to Editors
The Health Committee will publish its Fourth Report of Session 2002-03 on Provision of Maternity Services in the UK on Wednesday 18 June at 00.01 am. A press conference will be held at 9.30 am in Committee Room 16 on Wednesday 18 June.
Although childbirth is now safer than ever before, some women still go without the kind of advice and support that they need, throughout and after their pregnancies, to secure the best possible health outcomes for themselves and for their babies. In December 2002 the Health Committee appointed a Sub-committee to undertake a series of short inquiries in this area. In its first inquiry the Sub-committee set out to look at the services available to women in England today, at the variation in these services across the country, and at four issues of particular concern: the collection of data from maternity units, caesarean section rates, the staffing structure of maternity care teams, and the provision of training for health professionals who advise pregnant women and new mothers.
Following publication, copies of the Report will be on sale from the usual Stationery Office outlets (tel. 0845 702 3473) and the Parliamentary Bookshop (tel. 020 7219 3890). Following publication the Report may also be viewed at
The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No. 152 to examine the expenditure, administration and policy of the Department of Health and associated public bodies. The Committee has power to send for persons, papers and records. The Maternity Services Sub-committee, which was nominated on 12 December 2002, is appointed under Standing Order No. 152 and has the power to send for persons, papers and records.