There is substantial variation in maternity care processes and outcomes among maternity care providers: what can midwives do with the evidence from the 2016/17 clinical report from the National Maternity and Perinatal Audit
After three years, The National Maternity and Perinatal Audit (NMPA) continues to provide evidence of substantial variation in the care of women and babies in Great Britain. Whilst some variation is inevitable and may reflect personalised care, all providers of maternity care, including midwives, need to reflect on this variation and ask the question, “Are we delivering the highest standard of care to all?” If not, “What can we do about it?” Drawing upon the results of the 2016/17 NMPA Clinical Report, the significant variation in processes and outcomes for women and babies giving birth in different NHS Trusts/boards will be presented. For the first time variation in a ‘Birth Without Intervention’ measure (BWI) is reported for England, with the proportion of women experiencing BWI varying from 23% to 48%. The proportion of women experiencing Induction of labour also varies from 17-43%. Even more concerning is the variation seen in the proportion of women experiencing a 3rd or 4th degree tear (<1%-7.9%) or a blood loss of 1500 mls or more (<1%-5.4%) and in babies born with an Apgar score below 7 (0.4%-3.6%. Variation in these three measures is seen as so significant for women and babies that providers who have results above the ‘expected’ range are reported to the relevant healthcare regulator and asked to investigate and develop action plans for improvement. Midwives will be challenged to reflect on the variation seen at national level, encouraged to compare findings for their local service with others around the country and against the national mean and encouraged to reflect on what they are doing well and areas that can be improved in the care of women and babies. Through the sharing of actions others maternity care providers have undertaken as a result of NMPA findings, midwives will also be encouraged to get involved in local quality improvement initiatives that address unnecessary variation in care processes and outcome for the benefit of all women and their babies.
The National Maternity and Perinatal Audit is commissioned by HQIP on behalf of NHS England and the Scottish and Welsh governments. The RCOG in collaboration with the RCM, RCPCH and LSHTM deliver the audit.
Citation : Harris, T., (2019) There is substantial variation in maternity care processes and outcomes among maternity care providers. What can midwives do with the evidence from the 2016/17 clinical report from the National Maternity and Perinatal Audit. Oral presentation. International Maternity Expo 12-13/11/19. London, Millenium Gloucester Hotel.
Research Institute : Centre for Reproduction Research (CRR)
Peer Reviewed : Yes