In addition to the feedback from women and other interested parties through our regional drop in events, service visits and online, and evidence received to the National Maternity Review inbox by email, the review commissioned the National Perinatal Epidemiology Unit (NPEU) at Oxford University to summarise and add to the evidence where possible on the following questions:
- Safety of place of birth
- Effectiveness of 24/7 consultant labour ward cover in large units
- Factors which influence women’s choice of planned place of birth
- International evidence on the delivery of and outcomes from maternity services
How has the issue of safety been addressed?
Safety has been at the heart of all of the Review’s work. We have worked with experts from across the service, including the Care Quality Commission, the regulator for safety and quality. The workstream led by Dr Bill Kirkup delivered a full assessment of the variation in outcomes in maternity services in England, to inform the Review’s work.
Maternity services in England are safer than ever and satisfaction is rising. However, we know there is unwarranted variation in maternity services across the country. The National Maternity Review report recommends a focus on continuous improvement everywhere so that all women have access to the best possible care.
Doctors and midwives told us that things go wrong too often and the fear of litigation and of being blamed prevents learning from what happened.
Safety should underpin every aspect of maternity care provision, and this means that:
- Women should be informed of risks and be supported to make decisions which would keep them as safe as possible
- There should be rapid referral and access to more specialist services when they are needed
- Women should have continuity in the person who is caring for them, their midwife and, where appropriate, their obstetrician
- Professionals should work together in a multi-professional team in the interests of the woman and her baby, seeking to keep them as safe as possible
- Staff and teams must continuously measure the quality of their services
- When things go wrong, there should be a rapid investigation, support for staff involved, openness and honesty with the family, and provision made for their needs through a rapid resolution and redress system
- The leadership of all provider organisations must take responsibility for and attach priority to the safety of their maternity services; and
- Providers should work together as part of a Local Maternity System to ensure that services are provided to meet the woman’s choices and ensure that women and their babies are kept as safe as possible
The Review recommends that there needs to be a national drive for investigation, honesty and learning when things go wrong so that we can ensure that we make services better.
How were service users represented on the Review Panel?
The Review panel was carefully assembled to provide a balance of perspectives and the interests of women and their families have been at the centre of all of our work.
The Review team included individuals from the National Childbirth Trust (NCT) and Mumsnet which represent women and families, as well as the Stillbirth and Neonatal Death Charity (Sands) which represents women and families who have experienced the loss of a baby.