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Experts Find ‘Substantial’ Variation in Maternity Care

Special Reports

Experts are warning that there is “substantial variation” in maternity care practice around England which is of concern, in a report published this year.

The patterns of maternity care in English NHS trusts report, published by the Royal College of Obstetricians and Gynaecologists (RCOG) in collaboration with the London School of Hygiene & Tropical Medicine highlights differences in the care received by women giving birth in hospitals across England.

Overall, just over half (55%) of all first-time mothers had some form of intervention during labour and delivery, and the report indicates considerable variation across maternity units in the types of intervention given and the outcomes these women experienced. For example, there was a 1.5 to two-fold difference between NHS trusts with the lowest and highest rates of emergency caesarean sections (8% and 15%) when comparing the 10% of hospitals with lowest
rates with the 10% of hospitals with the highest rates.

Among first-mothers who had vaginal delivery, a similar amount of variation was seen in the rates of instrumental delivery (19% and 29%) and episiotomy (29% and 44%). The report authors reviewed more than 550,000 births and looked at official HES (Hospital Episode Statistics) data on births in 2013-14, excluding non-standard deliveries such as twins, triplets and pre-term babie.

The RCOG said the report gave a perspective on patterns of care during labour and delivery, enabling NHS trusts to examine their own practice in context and ensure their services were meeting the needs of women and their families.

Some variation in care was to be expected, said the authors, and could reflect a service that was tailored to the specific needs and preferences of individual patients or populations. Results were adjusted to take into account risk factors beyond the control of individual trusts, such as a woman’s previous birth history, age and level of social deprivation. However, the authors warned that some of the observed differences could be due to differences in the quality of the data submitted by trusts, as well as differences in patient characteristics that were not possible to take into account, such as smoking and obesity.

Nevertheless, the variation could also suggest that not all women were getting the best possible care across the country or that NHS resources were not being used in the most efficient way. Dr David Richmond, RCOG president said: “The RCOG is dedicated to creating a culture of openness and transparency within maternity and gynaecological care. With this information, maternity services, alongside commissioners, will be able to move towards identifying priority areas for reducing variation and further improving the safety and quality of care provided to women and their babies.”

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