London School of Hygiene & Tropical Medicine

Expectant mothers in England experience wide variations in their quality of care, according to a new report from the London School of Hygiene & Tropical Medicine and the Royal College of Obstetricians and Gynaecologists.

The report presents a series of indicators that can be used to compare the performance of English maternity units and reveals considerable variation among maternity units in England. For example, among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour (17% compared to 38%), emergency caesarean section after induction of labour (20% to 40%) and instrumental delivery (16% to 32%).

This variation is a source of concern as it could suggest that not all women are getting the best possible care, or that NHS resources are not being used in the most efficient way. However, the report's authors caution against over-interpreting the findings. Some of the observed variation could be due to differences in the quality of the data submitted by hospitals, and differences in patient characteristics that were not possible to control for.

Researchers at the London School of Hygiene & Tropical Medicine used Hospital Episode Statistics (HES) data from 2011/12 that is routinely collected by NHS hospitals. For the first time, they analysed this data in a way that enables fairer comparisons to be made between hospitals. The researchers have controlled for factors that increase the risk of a poor pregnancy outcome, but which are beyond the control of the hospital, such as the medical history of the mother.

The report includes eleven indicators including emergency maternal readmission within 30 days of delivery, third and fourth degree perineal tear rate amongst unassisted and assisted vaginal delivery and elective caesarean section rate.

A number of recommendations are made for in the report. These include a call for units to use the indicators as a basis for reflection upon current practice, and that units should audit themselves against existing clinical guidelines to help identify causes of variation at a local level. The report also highlights the need for clinicians to take ownership of their own data in order to drive up data quality.

Dr David Cromwell, senior lecturer in health services research and co-author of the report, said: "We hope the report will enable clinicians and maternity units to more easily review their work in comparison to their peers, and that this will lead to better care for women and their babies."

This report will now be produced annually to cover the whole of the UK and will expand the suite of indicators to include neonatal outcomes and patient experience. Individual hospitals and maternity units have not been named in this first report but will be from next year.

View the full report on the Royal College of Obstetricians and Gynaecologists website