Having a baby in Scotland 2013: Women's experiences of maternity care

6. Chapter 6: Comparison of Results with the English Maternity Services Survey 2013

6.1. The Scottish survey was undertaken concurrently with the English maternity services survey (2013) using the same questionnaire, with only minor modifications for use in the Scottish context and this has allowed some comparison of results. There are significant differences between the organisation and monitoring of maternity care in Scotland and England however the requirement for the provision safe, effective and women centred care and indicators of quality of care are the same. A full comparison of results for questions contained in both the Scottish and English questionnaires is included in this report as Appendix 2. Comparisons have only been made where questions were the same or very similarly worded in both questionnaires.

6.2. There are around 700,000 annual births in England compared to approximately 58,000 births in Scotland each year therefore the Scottish survey sample was relatively small in comparison to the sample of the English survey. Further the 2013 survey in England was the third in a series of maternity service surveys while the Scottish survey was the first of its kind in recent years. The report of the English maternity survey is available at: http://www.cqc.org.uk/public/publications/surveys/maternity-services-survey-2013.

6.3. Both surveys obtained a very similar response rate (46% England; 48% Scotland) and both received similar response rates for first time mothers and mothers who have had babies previously ( Appendix 2, Table 36). The demographic details of each questionnaire are more relevant to their specific context rather than to cross country comparison therefore comparisons have only been made for questions relating to women's experiences of care. Broadly, comparisons appear to show that women's experiences of care are very similar across all of the stages of maternity care. Differences highlighted below are likely to be significant however, they are likely to reflect known factors such as greater population density in England meaning that a wider range of maternity units are accessible to women, different maternity staffing levels and behavioural differences such as long standing lower rates of breastfeeding in Scotland.

6.4. Considering care during pregnancy the surveys both found that around 90% of women had their booking visit by 12 weeks of pregnancy and that around one third of women first saw their midwife when they thought they were pregnant (Appendix 2, Table 38). A higher proportion of women responding to the English survey reported being given choice of place of birth than in the Scottish survey, for example 60% of women in England compared to 41% in Scotland said that they were offered a choice of hospital for birth and 38% in England compared with 25% in Scotland said they were offered a choice of home birth (Appendix 2, Table 42).

6.5. Almost all women in both surveys said that they were given a telephone contact number for their midwife/ midwifery team. For the women who used this telephone number during their pregnancy 82% in Scotland and 70% in England said that they were always given the help they needed (Appendix 2, Table 40). Women in Scotland were more likely to report that they were always given enough time to ask questions during their antenatal check-ups compared to women in England (82% and 74%, respectively) (Appendix 2, Table 45).

6.6. During labour and birth there were very few differences apparent in women's experience of care. Slightly more women in Scotland give birth by caesarean section and more women in England said that they were left alone during labour or birth at a time when it worried them (25% in England compared to 20% in Scotland) ( Appendix 2, Table 52).

6.7. There were some differences in women's experiences of postnatal care. More women in the English survey said that they left hospital within 24 hours of giving birth (36% in England compared to 27% in Scotland) (Appendix 2, Table 55). Women in Scotland reported seeing a midwife more often than women in England, for example 9% of women in the Scottish survey said that they saw a midwife only one or two times compared to 25% of women in the English survey. Sixteen per cent of women in the Scottish survey said that they would like to see a midwife more often compared to 21% of women in England (Appendix 2, Tables 61 & 62). In the six weeks following birth 78% of women in Scotland said that they definitely received help and advice about their baby's health and progress, compared to 70% of women in England (Appendix 2, Table 67).

6.8. A strength of the English maternity service survey 2013 is that it is the third in a series of similar surveys, the most recent conducted in 2010. Results may therefore be presented as comparisons with previous results to map progress against maternity care targets over time and to demonstrate some improvements in aspects women's experience that may give some cause for concern. For example, the percentage of women in the 2013 survey, who reported that they were left alone when it concerned them during labour and birth had decreased from the results of the 2010 survey. In contrast the Scottish survey is the first national survey of maternity care undertaken in recent years therefore it has only been possible to benchmark performance against maternity care policy and guidance and to compare performance across NHS Boards although these may differ in geographical and demographic characteristics.

6.9. Comparison of results from the Scottish survey with the English survey results has identified far more similarities than differences between women's experiences of maternity care. Both report similar positive findings particularly in relation to examples of good communication between mothers and midwives at all stages of care and the achievement of targets in relation to early antenatal access to maternity care. Similar areas for concern were also identified, for example both surveys found that advice about infant feeding was sometimes lacking or inconsistent and that recommended levels of continuity of care were not always met. However questions about continuity of care were asked differently in the questionnaires making direct comparisons difficult. Maternity services in Scotland and England are increasingly divergent in their commissioning processes and organisational structure. However, aspirations for quality of maternity care are the same and it appears that maternity services in both countries face very similar challenges to improvement in women's experience of maternity care.