Many women still positive about their maternity care – but pandemic impacted on choice and involvement and increased concerns about postnatal support

Published today (Thursday 10 February), the findings of CQC’s 2021 maternity survey capture the views of more than 23,000 women who gave birth during February 2021 – when the country was in the middle of its third national COVID-19 lockdown. The survey asked those women about all aspects of their maternity care experience from the first time they saw a clinician or midwife, during labour and birth, through to the care provided at home in the weeks following the arrival of their baby.

The majority of respondents were positive about their interactions with staff and an increasing number said they were able to see or speak to the same midwife at every antenatal or postnatal check-up compared to the last time the survey was carried out in 2019.

The results also show that more women who took part in the survey were asked about their mental health during antenatal appointments than in 2019 and that the majority (83%) felt that they were given enough support for their mental health during their pregnancy.

However, the results indicate a decline in a number of areas, likely reflecting the impact of that lockdown restrictions and social distancing requirements had on services and staff.

In 2021, a fifth of women surveyed said they were not offered any choices about where to have their baby. Compared with 2019, a greater number also said that their partner or someone else close to them was not able to be involved in their care during labour and birth, and that they would have liked more information and support postnatally.

The survey was introduced to the CQC’s NHS patient survey programme in 2007, but in 2021 – for the first time – respondents were able to complete the questionnaire online as well as by post leading to a substantial increase in response rate from 36% in 2019 to 52% in 2021, with 89% of women taking part online. There were also positive changes to the profile of women choosing to complete the survey, with an increase in responses from Asian and Asian British women (9% in 2019 and 11% in 2021) and from those describing themselves as having ‘no religion’ (41% in in 2019 and 45% in 2021) or ‘Muslim’ (6% in 2019 and 8% in 2021). This suggests that the new methodology has led to greater uptake from different demographic groups, helping to make the results more representative.

Responses to the 2021 survey include the following notable trends:

• Forty-one per cent of women said they saw or spoke to the same midwife every time during their antenatal check-ups, up from 37% who said this in 2019. And, although less than a fifth of women (19%) said that any of the midwives who cared for them in hospital had been involved in their antenatal care, this is up from 16% in 2019.
• The vast majority of women (86%) surveyed in 2021 said that they were ‘always’ spoken to in a way they could understand during their antenatal check-ups (down slightly from 89% in 2019).
• The proportion of women who said that they were ‘always’ treated with kindness and understanding while in hospital after the birth also remained relatively high, however fell from 76% in 2019 to 71% in 2021.
• More women in 2021 (69%) said that during their antenatal check-ups, the midwife ‘definitely’ asked them about their mental health than in 2019 (67%) and most women (83%) said that if they needed it, they were given enough support for their mental health during their pregnancy.
• There was a large decline in the proportion of women who said that during their stay in hospital, if their partner or someone else close to them was involved in their care, they were able to stay with them as much as they wanted – down from 74% in 2019 to 34% in 2021.
• A fifth of women surveyed (20%) said they were not offered any choices about where to have their baby. And the majority (62%) were not given a choice about where their postnatal care would take place, much higher than the 52% who said this in 2019.
• Sixty-five per cent of women said that they were ‘always’ able to get a member of staff to help them if they needed it during labour and birth, down from 72% in 2019. And exactly half of women surveyed (50%) felt they ‘completely’ had opportunities to ask questions about their labour and birth if they wanted to, down from 56% in 2019.
• Less than three-fifths of women (56%) were ‘definitely’ given information about any changes they might experience to their mental health after having their baby, down from 63% who said this in 2019. And, just under three quarters (73%) who contacted a midwifery or health visiting team postnatally were ‘always’ given the help they needed compared with 79% in 2019.
• The proportion of women who said that in the six weeks after the birth of their baby, they ‘definitely’ received help and advice from health professionals about their baby’s health and progress, if they needed this, fell from 71% in 2019 to 60% in 2021.

Commenting on the survey, Ted Baker, CQC’s Chief Inspector of Hospitals, said:

“This year’s survey captures feedback from women who experienced their antenatal appointments, birth and labour, and postnatal care under pandemic conditions. Maternity services were directly impacted by national restrictions on social distancing and many trusts faced staff shortages due to redeployment, illness and self-isolation requirements.

“Given this context, I am pleased to see that many women surveyed had a positive experience – and that slight improvements were evident in terms of continuity of carer and mental health support during pregnancy. This is a testament to the efforts of staff working hard to provide care for pregnant women and new mothers – even when up against unprecedented pressures.

“That said, we cannot ignore the fact that the year on year improvement we have seen with previous years surveys has stalled, and in some cases, women are reporting poorer experiences. The pandemic brought about changes that limited choice and partner involvement and the impact is reflected very clearly in the survey results.

“It is also extremely disappointing that postnatal experiences continue to fall significantly short, with the pandemic exacerbating existing concerns about the need for better information and support for women in the weeks and months after giving birth.

“While COVID-19 restrictions have eased since the survey was carried out, the challenges for NHS trusts providing care in the current climate remain. These results offer valuable insight that NHS trusts can use to understand what women using their maternity services really think. This will help them to identify where they may be able to make changes, within the resources they have available, to ensure consistently good experience for all women and their families.”

“Alongside this, CQC is committed to working together with partner organisations, staff working in maternity services and those using them to play our part in supporting further improvements in care.”

The full results for England, are available on the CQC’s website at www.cqc.org.uk/maternitysurvey

This is the eighth survey of its kind that CQC has carried out to help trusts better understand the experiences of women using maternity services and involved 122 NHS acute trusts. The results are used by CQC as part of its wider monitoring of hospital services.