London School of Hygiene & Tropical Medicine

Differences in the care received by women giving birth in hospitals across England are highlighted in a state of the nation report carried out by the Royal College of Obstetricians and Gynaecologists (RCOG) in collaboration with the London School of Hygiene & Tropical Medicine.

The report, which is based on NHS childbirth data for 2013-14, gives a national perspective on patterns of care during labour and delivery, enabling NHS trusts to examine their own practice in context and ensure their services meet the needs of women and their families. It highlights different rates of emergency caesarean sections, instrumental deliveries and episiotomies, (which is when an incision is made in a woman's perineum - the area between the vagina and anus - during childbirth).

Overall, 55% of all first-time mothers had some form of intervention during labour and delivery, and the report indicates considerable variation across maternity units in the types of intervention given and the outcomes these women experienced. For example, there was a 1.5 to two-fold difference between NHS trusts with the lowest and highest rates of emergency caesarean sections - ranging from 8% to 15% (when comparing the 10% of hospitals with the lowest rates with the 10% of hospitals with the highest rates.)

Among first-time mothers who had a vaginal delivery, a similar amount of variation was seen in the rates of instrumental delivery (ranging from 19% to 29%) and episiotomy (29% to 44%).

Some variation in care is to be expected and may reflect a service that is tailored to the specific needs and preferences of individual patients or populations. The results have been adjusted to control for risk factors that are beyond the control of individual trusts, such as a woman's previous birth history, age and level of social deprivation.

The authors caution that some of the observed differences could be due to variations in the quality of the data submitted by trusts, as well as differences in patient characteristics that were not possible to control for, for example smoking and obesity. However, they say the variation may also suggest that not all women are getting the best possible care across the country or that NHS resources are not being used in the most efficient way.

The report identifies that more than 10% of hospital trusts failed all data quality checks, and it calls for greater NHS trust engagement in ensuring that IT systems are fit for purpose.

Dr David Richmond, President of RCOG, said: "We are concerned about the amount of variation identified in this report. Although the exact causes are difficult to establish, it is paramount that maternity units have information about their services, as well as the ability to compare themselves to the national average and to their peers.

"The RCOG is dedicated to creating a culture of openness and transparency within maternity and gynaecological care. With this information, maternity services, alongside commissioners, will be able to move towards identifying priority areas for reducing variation and further improving the safety and quality of care provided to women and their babies."

Dr David Cromwell, co-author of the report and Reader in Health Services Research at the London School of Hygiene & Tropical Medicine, said: "Despite a continued need for improvements in data quality across the NHS, the information provided to trusts within this report will help them to monitor local practice and deliver consistently good care throughout the country.

"Since we started sharing these findings in 2013, we have already seen excellent examples of trusts using the data to identify clinical issues and make improvements. Providing data to empower individual trusts to take action is exactly why we undertook this project."

For the first time, the report information can be accessed in an interactive format on a new website.

The RCOG and the London School of Hygiene & Tropical Medicine, in partnership with the Royal College of Midwives and Royal College of Paediatrics and Child Health, will build on this work with the National Maternity and Perinatal Audit, which will evaluate the quality of care received by women and newborns cared for by hospital services in England, Wales and Scotland.

Publication:

• Patterns of maternity care in English NHS trusts 2013/14. (March 2016)