Maternity services

Introduction

Maternity services cover a range of services available throughout pregnancy upto the first year of birth. The NHS England 2012 Clinical Commissioning Resource Pack indicated over 700,000 women use maternity services each year in the UK.

Having a baby is the main reason for admissions and with the number of pregnancy related admissions continuously growing, it is vital that maternity services are provided by both primary care and specialist services to maintain a high level of care for mothers and babies.

Key inequalities and risk factors

The Marmot report sets out the priorities for reducing inequalities in health across England. The report highlighted the importance of giving every child the best start in life and the effect that has on the health of our population. Providing effective and high quality maternity care is a key element of giving our children the best start in life.

Every woman, every pregnancy, every baby and every family is different. However, there are a number of more common risk factors to mother and child which maternity services should seek to mitigate:

• Age – In Bracknell Forest the number of women giving birth over the age of 35 increased from just below 300 in 2002 to around 380 in 2010 falling to 314 in 2014/15 (equivalent to 23% which was higher than the 20.4% for England) and older mothers and their infants are more likely to experience adverse outcomes than younger women
• Obesity – Maternity obesity has become one of the most commonly occuring risk factors in obstetric practice associated with increased risk of serious health outcomes during pregnancy and child birth
• Smoking – – and its well documented harms to mother and baby. In 2015/16 6.3% of maternities had smoking recorded at time of delivery, which is significantly better that the national rate of 10.6%
• Ethnicity and deprivation – Office of National Statistics (ONS) data shows that mothers with a Black or Asian background have higher rates of neonatal and infant deaths, and babies with African, Asian and Caribbean ethnicity also having higher rates of low birth weights. Fewer than 500 of the 1,736 live births in Bracknell and Ascot CCG were to mothers born outside of the UK
• Long term conditions – The Royal Berkshire Hospital is reporting higher number of maternity cases with diabetes and heart disease which leads to more complex maternity care
• Caesarean section rates – National Institute for Health and Care Excellence (NICE) have published guidelines for caesarean sections. Whilst there is not a defined optimal percentage, rates vary and reasons for this need further consideration

Multiple morbities and social factors such as deprivation, substance misuse and domestic violence also  complicate maternal health and how professionals might respond. The causes of maternal death, risk factors and mitigating approaches are comprehensively analysed and addressed in the extensive 2014 MBRRACEUK report Saving Lives, Improving Mothers’ Care.

Facts, figures and trends

The 2013 National Audit Office report on the quality and effectiveness of maternity services notes the number of births has increased by almost a quarter in the last decade and is currently at its highest level for 40 years, placing increasing demands on NHS maternity services.

Over recent years there has also been an increase in the proportion of ‘complex’ births, such as multiple births (for example twins) and those involving women over 40 or women with obesity or pre-existing medical conditions. These complexities increase the risks of childbirth, meaning care often requires greater clinical involvement.

The “Capacity review of Maternity services in Berkshire” (Solutions for Public Health, 2013) noted differing usage for hospitals available to mothers in Bracknell Forest.  Usage was skewed due to capacity and choice: in 2012/13 there were 57 women diverted to another provider due to closure of the Royal Berkshire Hospital and the main reasons for closure were capacity (11 occasions) and midwifery staffing (22 occasions) and in terms of choice 65% of mother’s registered with Bracknell and Ascot Clinical Commissioning Group (CCG) use maternity services at Frimley Park Hospital (Frimley), 20% use Wexham Park Hospital (Slough) and 10% use the Royal Berkshire Hospital (Reading).

Births

The number of live births in Bracknell Forest in 2015 was 1,488. Expressing data as the number of live births per 1,000 female population allows for a south east and England comparison:

Term births

NHS Maternity Statistics for 2015/16 record the majority of births in Frimley Health and Royal Berkshire Hospitals occur within the 38-40 week gestational period and the rates are higher than the England average of 64.6% at 66.2% and 66.7% respectively.

The percentage of births before the 38-40 period (pre-term) is lower than the England average (15.3%), although the proportion of ‘overdue’ births (past 40 weeks) is higher than the England average (20.1%) at 22% for Frimley Health and 21.5% for the Royal Berkshire Hospital.

The ‘due’ date is given by a midwife or GP only to indicate a likely time for the birth, not the best time for a baby to be born.  Mothers will be offered the choice of being induced if they are overdue, late or post-term as births over 42 weeks carry a higher risk of still birth.

Caesarian sections (C-section)

Whilst a common procedure, a C-section is major abdominal surgery. Risks include increased likelihood of: infection to the wound, infection of the womb lining (endometritis), womb pain, heavy bleeding, blot clots and damage to the bladder or ureter.

A comparison of the NHS Maternity Statistics for 2013/14, 2014/15 and 2015/16 shows the percentage of Caesarian births is higher in the Royal Berkshire hospital than in Frimley Health hospitals, although the rates are similar to the England average but that all figures are increasing year on year:

Caesarian births also lead to additional stays in hospitals. Rates are lower in the Royal Berkshire Hospital than in Frimley, although figures for local hospitals are similar to the England average:

Predicted growth

The “Capacity review of Maternity services in Berkshire” (Solutions for Public Health, 2013) estimated that the Berkshire birth rate would rise by 9% by 2020 using fertility rate projections with a varying rate across CCGs.

However, reviewing ONS birth summary data since 2009, both annual fertility rates (TFR – the number of children a women might expect to have throughout her child bearing lifespan) is in decline:

As are conception rates (accessed 7 January 2017):

The ONS birth summary report suggests that reasons for the decreases in are likely to vary by age, social status, and number of other children. For example, older women may feel less inclined to delay having children than younger women, while at any age childbearing choices may be affected by parents’ current financial or housing position. Also, women who have already had children and who may be considering having another child will be influenced by different factors to those who have not yet had children.

Low birth weights

A baby is defined as being a low birth weight if they are under 2,500g and a gestational age of at least 37 complete weeks. Low birth weight is an issue because it increases the risk of childhood mortality, developmental problems in childhood and also indicates a risk of poorer health in later life.

The percentage of all live births at term with low birth weight (accessed 6 January 2017) is reported annually in the Public Health Outcomes Framework.  Between 2010 and 2014, of the 136 live births born at a low birth weight in Bracknell Forest, the percentage of live births with low birth weight has remained constant at the England and south east area levels.  Since 2010, the percentage has fallen in Bracknell Forest to a level that is significantly lower than the 2014 England figure (accessed 6 January 2017):

Looking at low birth weight as a proportion (%) of all births (live and still birth) between 2008 and 2012, ward level (2013) data shows that levels of low birth weight vary between 4.2% and 8.6% (accessed 16 June 2016):

The wards with the highest levels of low birth weight are Bullbrook, Harmans Water, Central Sandhurst and Wildridings and Central:

Want to know more?

Maternity care is under pressure in Berkshire due to increasing complexity of births. Local commissioners are developing actions to ensure that the accessibility, quality and safety of the services are protected and developed in a cost effective way.  This includes encouraging high quality safe home births (aiming to increase the home birth rate to at least 5% on average across Berkshire) and to increase the support to women at higher risk of complications during pregnancy (for example those with diabetes, obesity, and substance misuse to ensure a reduction in complications during birth).

Better Births – A National Maternity Review (NHS England, 2016) – a five year improvement plan to make care safer and give women greater control and more choices and to build upon the quality and outcomes of maternity services which have improved over the last decade despite births requiring increasingly complex care.

National Child and Maternal Health Intelligence Network – Dynamic Report for Bracknell Forest gives high level statistical data and analysis on low birth weight of term babies

NHS Digital Maternity Statistics – detailed information and maternity data comparable at national, regional and provider level.

Quality and safety are essential in the delivery of maternity care to ensure we get the best outcomes for babies and mothers. There is a strong national framework for maternity services with significant national policy and guidance including:

• Clinical standards – Royal College of Obstetricians and Gynaecologists guidance series and clinical practice and guidance from the Royal College of Midwives
• Risk management – NHS Litigation Authority
• Pathways – for maternity care and maternity settings from the National Institute for Health and Clinical Excellence
• Performance, outcomes and standards – NHS England 2012 Clinical Commissioning Resource Pack

Saving Lives, Improving Mothers’ Care (Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (Eds.) on behalf of MBRRACEUK, 2014) – A review of causes and trends and lessons learned from UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012 with a focus on the actions, small and large, to improve the quality of maternity care.  Intended for consideration by policy-makers, service planners and commissioners, public health and professional organisations, medical directors, clinical directors, doctors, midwives and allied health professionals.

 

This page was created on 27 February 2014 and updated on 7 January 2017. Next update expedcted December 2017.

Cite this page:

Bracknell Forest Council. (2017). JSNA – Maternity Services. Available at: jsna.bracknell-forest.gov.uk/starting-well/maternity/maternity-services (Accessed: dd Mmmm yyyy)

 

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