Having a Baby in Scotland 2015: Maternity Care Survey

Chapter 1: Introduction: The Context of the Maternity Experience Survey

Introduction

1.1 This report presents the national findings of the 2015 Scottish Maternity Care Survey, describing the experiences of more than 2,000 women who gave birth in Scotland during February and March 2015.

1.2 Having a baby is one of the most common reasons for hospital admissions in the UK and for this reason maternity services have been described as the 'shop window' of the NHS^[1]. Within Scotland around 58,000 women give birth each year almost all receiving care from maternity services involving multi-professional teams including midwives, obstetricians, general practitioners, paediatricians, and many more. The Scottish Government is committed to improving outcomes for children and young people, to eliminating the impacts of inequalities and to making Scotland the best place in the world for children and young people to grow up (www.gov.scot/Topics/People/Young-People). Central to this ambition is the universal provision of early access to safe and effective maternity care, personalised to the individual needs and circumstances of women, that promotes their long term health and wellbeing and that of their newborn infants and families. Understanding the experiences of women who have recently used maternity services is an essential part of providing high quality maternity care. While some aspects of NHS care quality will continue to be regularly monitored through a range of methods, many important aspects of quality can only be assessed by asking those who have recently used maternity care services to describe their experiences. Through listening to the experiences of mothers' maternity service providers and policy makers can understand what is working well and where and why services are falling short of the high quality care that all mothers and babies require.

1.3 This survey provides comprehensive information about women's experiences of maternity care in Scotland in 2015 and repeats the survey undertaken in 2013. The majority of questions are the same and this allows for comparison of results between the two time points. The survey asked questions on each stage of the maternity care journey; during pregnancy, during labour and birth, and postnatal care in hospital and at home. Within each of these stages, questions are focussed on important indicators of care quality such as involvement in decision making, continuity of care and being offered choices. At the end of each section of the questionnaire women were asked 'If there is anything else that you would like to tell us about your care.......' and invited to provide free text comments specific to that stage. For the first time these comments have been incorporated into this report. These add considerably to the understanding of the main survey results providing increased insights into some of the results and highlighting issues that are important to women and areas where care falls short of women's expectations. The results will be used to inform the current review of maternity services in Scotland (www.gov.scot/Topics/People/Young-People/child-maternal-health/neonatal-maternity-review) to identify areas for service improvement and development at local and national levels.

1.4 This survey was undertaken as part of the Scottish Care Experience Survey Programme in partnership with the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP Research Unit). The Scottish Care Experience Survey Programme undertakes national surveys that aim to provide local and national information on the quality of health and social care services from the perspectives of those using them. Find out more about the Scottish Care Experience Survey Programme at: www.gov.scot/Topics/Statistics/Browse/Health/careexperience. The NMAHP Research Unit is a multidisciplinary national research unit, funded by the Scottish Government Health and Social Care Directorate Chief Scientist Office (CSO). The unit aims to conduct high quality applied research that enables Nurses, Midwives and Allied Health Professionals to make a difference to the lives of the people of Scotland and beyond. Find out more about the NMAHP Research Unit at: www.nmahp-ru.ac.uk.

1.5 This report presents the national level survey results. Results for individual NHS Boards are available at www.gov.scot/Topics/Statistics/Browse/Health/maternitysurvey/2015Results

Methods

1.6 A copy of the 2015 Scottish Maternity Care Survey questionnaire can be found at: www.gov.scot/Topics/Statistics/Browse/Health/maternitysurvey/2015Results.

1.7 Further details of the survey design, fieldwork and analysis are available in the Scottish Maternity Care Survey technical report www.gov.scot/stats/bulletins/01191.

1.8 Questionnaires were sent to 5,025 randomly selected women who gave birth in Scotland in February and March 2015. An approved patient survey contractor (Quality Health Ltd) was appointed to carry out the field work. Posters advertising the survey were distributed to all Scottish maternity units. The questionnaire was issued at the end of May 2015. Two postal reminders were sent to encourage mothers to respond and the final response deadline was the middle of August 2015. Women had the option to complete and return the paper version of the questionnaire, to complete the questionnaire online or via a telephone helpline in a wide range of languages. The helpline was also available to handle questions or complaints about the survey.

1.9 In total 2,036 women returned questionnaires giving an overall response rate of 41%.

1.10 The survey data were collected and coded by Quality Health Ltd and securely transferred to the Scottish Government for analysis. The completed, anonymised analyses were shared with NMAHP Research Unit in order to produce the national report.

1.11 With the exception of the 'Women who responded to the survey' section, the percentages presented in the report have been weighted in order to increase the representativeness of the results. Weights were applied to all survey responses based on the number of eligible mothers who gave birth in each hospital (or gave birth at home). This means that the contribution of each hospital to the NHS Board and Scotland results is proportional to the number of eligible mothers that gave birth there. Further information on how weights were calculated and applied can be found in the technical report.

1.12 We know that certain groups of women are more likely than others to respond to this survey. For example, the proportion of responses from older mothers was higher than for the population as a whole. The NMAHP Research Unit will be undertaking some additional analysis in 2016 to establish whether particular groups of women tend to report different experiences of maternity care.

1.13 Confidence intervals, which are included in most tables, provide the range (the 95% confidence interval) within which the true value is likely to lie. Where questions in the 2013 and 2015 surveys were identical, results have been compared using the appropriate statistical tests.

1.14 The questionnaire contained free text boxes in which women were invited to 'tell us about your care' at the end of each of the survey sections (antenatal care, care in labour, postnatal care in hospital and postnatal care at home). In total 1,244 of the returned surveys included 'free text' comments, meaning that just over 61% of the women who completed the survey chose to comment in response to at least one of the above open questions. As women chose whether or not to provide comment on their experiences, the sample is not necessarily fully representative, but was found to contain a broad range of opinion. There were a total of 2,667 comments meaning that some women answered more than one 'free text' question. 620 women made a comment on their antenatal care, 755 commented on their care during labour and birth, 757 commented on their postnatal care in hospital and 535 on their care at home following birth.

1.15 These comments were analysed thematically^[2],[3] using a process of detailed coding and 'constant comparison'^[4]. The results of this analysis and a selection of the comments made by women are presented within the report. Full details of the methods used for the qualitative analysis are included in the survey technical report www.gov.scot/stats/bulletins/01191.

Presentation of results

1.16 In the following chapters results are presented by stages of the maternity care journey; care during pregnancy, care during labour and birth, postnatal care at hospital and at home. Within each chapter results are presented for key themes relevant to the particular stage, with comparison between the results of the 2013 and 2015 surveys where possible.

1.17 Data is presented in tables with a focus on percentages. Different response rates were achieved for each question and where appropriate filter questions were used to direct women away from responding to questions that were not relevant to them. The number of responses for each question is presented to provide additional context. Please note that this provides the unweighted number of women who responded to each question.

1.18 In general results are shown as the percentage of women who answered each question positively. Percentages for each question are calculated excluding any women from the denominator who did not answer the question or answered "not relevant" or "don't know". Percentages have been rounded to the nearest whole number, in some situations this means that the total percentage does not reach 100%.

1.19 Findings of the analysis of the free text additional comments are presented at the end of each section. This report can only contain a relatively small number of the many comments made. Comments that related to very specific clinical issues have not been included, however all of the comments have been sent to the appropriate NHS Boards with their respective survey reports and so all of the comments will be noted and used to inform service improvements.

Women who responded to the survey

1.20 The mean age range of women responding to the survey was 31 years of age, ranging from 17 to 50 (Table 1). Most of the women who responded were aged between 25 and 34 (60%), or over 35 years (30%) with only 10% of the respondents in the under 24 age group. In 2015 around 21% of births in Scotland were to mothers aged 24 or under (www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/) indicating that the survey is likely to be underrepresented for this group of mothers. For 42% of mothers this was their first pregnancy while 58% said that they had been pregnant before.

Table 1. Description of survey respondents

What was your age on your last birthday?
	2013		2015
	Number	%	Number	%
Under 24	339	15	210	10
25-34	1,322	57	1,205	60
Over 35	661	28	594	30
TOTAL	2,322	100	2,009	100
Have you had a previous pregnancy?
	2013		2015
	Number	%	Number	%
Yes	1,355	58	1,160	58
No	971	42	839	42
TOTAL	2,326	100	1,999	100
How many babies have you given birth to before this pregnancy?
	2013		2015
	Number	%	Number	%
None	160	12	127	11
1-2	1,090	80	958	82
3 or more	112	8	85	7
TOTAL	1,362	100	1,170	100

1.21 Almost all the women (94%) rated their general health as either very good or good (Table 2). Eleven per cent said that they had a long term physical or mental health condition although most said that this reduced their ability to carry out day to tasks only a little (36%) or not at all (55%).

Table 2. Self - reported health status

How would you rate your health in general?
	2013		2015
	Number	%	Number	%
Very good or good	2,205	94	1,903	94
Fair	117	5	101	5
Very bad or bad	8	<0.5	11	1
TOTAL	2,330	100	2,015	100
Do you have a physical or mental health condition or illness lasting or expected to last 12 months or more?
	2013		2015
	Number	%	Number	%
Yes	209	9	214	11
No	2,121	91	1,800	89
TOTAL	2,330	100	2,014	100
If yes, does your condition or illness reduce your ability to carry-out day-to-day activities?
	2013		2015
	Number	%	Number	%
Yes, a lot	23	11	19	9
Yes, a little	83	40	77	36
Not at all	102	49	117	55
TOTAL	208	100	213	100

Ethnicity, religion and sexual orientation

1.22 Around 7% of women responding to the survey belonged to minority ethnic groups. Around half (52%) identified themselves as having no religious view. The large majority of respondents (99%) described themselves as heterosexual/ straight with only 1% describing themselves as gay/ lesbian, bisexual or other (Table 3).

Table 3. Religion, sexual orientation and ethnicity

What religion, religious denomination or body do you belong to?
	2013		2015
	Number	%	Number	%
None	1,175	51	1,047	52
Church of Scotland	465	20	379	19
Roman Catholic	397	17	317	16
Other Christian	183	8	168	8
Muslim	60	3	51	3
Other religion	45	2	41	2
TOTAL	2,325	100	2,003	100
Which of the following best describes how you think of yourself?
	2013		2015
	Number	%	Number	%
Heterosexual/straight	2,287	99	1,971	99
Gay/lesbian, bisexual or Other	26	1	19	1
TOTAL	2,313	100	1,990	100
What is your ethnic group?
	2013		2015
	Number	%	Number	%
White	2,159	92	1,879	93
Asian, Asian Scottish or Asian British	105	4	86	4
Other ethnic group	74	4	58	3
TOTAL	2,338	100	2,023	100

1.23 The large majority of women (92%) gave birth at term (between 37 and 42 weeks of pregnancy) and most had one baby (98%), with only 28 sets of twins born to women who responded to the survey (Table 4).

Table 4. Birth and baby

Did you give birth to a single baby, twins or more in your most recent pregnancy?
	2013		2015
	% (n=2,356)	Confidence Interval	% (n=2,036)	Confidence Interval
A single baby	99	(98.5 , 99.2)	98	(97.9 , 99.0)
Twins	1	(0.7 , 1.5)	2	(1.0 , 2.1)
Triplets	<0.5		0
Roughly how many weeks pregnant were you when your baby was born?
	2013		2015
	% (n=2,334)	Confidence Interval	% (n=2,020)	Confidence Interval
Before I was 37 weeks pregnant	7	(6.0 , 7.9)	8	(6.9 , 9.1)
When I was 37 weeks pregnant or more	93	(92.1 , 94.0)	92	(90.9 , 93.1)