At the end of January 2019, the Care Quality Commission (CQC) released its annual report into maternity services, based on data from more that 17 600 women who gave birth in February 2018. While previous reports showed sustained improvements, the 2018 findings suggest that progress has stalled or even reversed.
Analysis confirms this conclusion: while the number of women being given a choice of place of birth had been gradually increasing, 15% said that they were offered no choice in both 2017 and 2018 (CQC, 2019), just one of the many findings that stayed the same. Similarly, there was no increase in the number of women seeing the same midwife for antenatal check-ups—despite studies that have proved the positive effects of continuity of carer on maternal and neonatal wellbeing (Moncrieff, 2018) and repeated calls from organisations such as the Royal College of Midwives (RCM).
With understandable concern, the response from the RCM also highlighted that this year's report showed several areas that appeared to be ‘going backwards’ (RCM, 2019). Postnatal care particularly suffered in this regard, with 56% of women in 2018 saying that they ‘definitely’ received enough information about the emotional changes they could experience after the birth, down from 59% in 2017. A similar proportion agreed that they had ‘definitely’ received enough information about the physical changes (53% in 2018, down from 57% in 2017). In addition, the number of women who were unable to receive support for feeding in the evenings and at weekends increased, from 22% in 2017 to 25% in 2018.
The report nevertheless highlighted many positive findings. A significant improvement was seen in women being asked antenatally about their emotional health, rising from 57% in 2015 to 64% in 2018, while a similar trajectory was shown in women having a partner or close friend with them in hospital for as long as they wished, which rose from 63% in 2015 to 71% in 2018. In addition, 88% said that they were ‘always’ treated with dignity and respect, and 85% of health professionals introduced themselves to women—doubtless thanks to the ‘Hello my name is’ campaign, started by Dr Kate Grainger MBE as a response to how clinicians communicated with her when she was a patient.
Of course, it can be disheartening to see that progress has slowed or declined, especially if previous years showed improvements (RCM, 2018). Nevertheless, these reports remind us to intervene before a problem becomes widespread. In many ways, the ‘Hello my name is’ campaign is the perfect example: it began in 2013, and by 2019, the CQC acknowledged it as the reason for health professionals’ improved relationships with women. As an intervention, it was cheap, easy, and targeted initially at just one person's care. The latest CQC report is therefore an important reminder that progress is neither linear nor smooth, but that care can be improved in the long term by managing stumbles on the path before they become major roadblocks.