HMN 2025: How Most women have positive experience of NHS maternity services

An independent evaluation of measures introduced by the NHS in 2019 to reduce stillbirths in England has shown that most women have a positive experience with antenatal care, birth and labor.

Two peer-reviewed studies led by University of Manchester researchers across 28 NHS maternity units are published today in the journals BMJ Open Quality and BMJ Quality and Safety.

The BMJ Open Quality paper showed 89% of women reported positive antenatal care and 86% had positive labor experiences.

However, the data from online surveys with 1,140 women and 633 health care professionals—carried out in 2023—also showed concerns around poor communication, lack of personalized care, staff shortages and delays still persist.

The Saving Babies’ Lives Care Bundle (SBLCB) was introduced in England in 2015 as the Government’s response to a stillbirth rate that was comparatively higher than many western countries.

SBLCB has evolved through three versions in 2016, 2019, and 2023, each building on the last to improve maternity care and reduce perinatal mortality across England.

The SBLCB evaluation of version 2 found it had been successfully rolled-out in the majority of NHS maternity providers and that midwives and frontline staff have a pivotal role in implementing it.

Women’s positive experiences were linked to feeling listened to, being involved in decision-making, effective communication and continuity of care.

They encountered staff, the researchers found, who acknowledged their history and made them feel able to ask questions.

However, their negative experiences often stemmed from poor communication and lack of personalized care, making them feel dismissed, especially when expressing concerns about reduced fetal movement and during labor.

Some of the women who had a negative labor or birth experience also reported disorganized and inconsistent care, staff shortages, lack of beds and poor pain management which left them feeling neglected.

Poor communication between staff made care feel disjointed and was further hindered by changes to electronic notes, they reported.

Risk factors were not always communicated effectively and women were often given no choice in their treatment, which meant they felt threatened or frustrated.

Alexander Heazell, is Professor of Obstetrics at The University of Manchester, Honorary Consultant Obstetrician at St Mary’s Hospital, and Director of the Tommy’s Stillbirth Research Center.

He said, “We analyzed a total of 1,071 women’s written responses about their antenatal care, of which 89% reported a positive experience. 86% had a positive experience of labor.

“So much progress has been made in terms of their experiences around feeling listened to and reassured, feeling in control of decision-making and encounters with staff and care.

“Our data suggest that elements of the SBLCBv2 are increasingly embedded in maternity care, but refinements are still needed.

“This will address variation in practice between units and support effective communication between health care professionals and service users to balance standardized clinical practice with personalized care.”

A second paper published in BMJ Quality and Safety examined the qualitative experiences of the women.

Lead author Dr. Holly Reid, also from The University of Manchester, said, “Our paper found that having a trusting relationship with maternity care providers is of paramount importance to achieve positive and safe maternity experiences for women.

“Trust was built through consensus among the care team, making sure the partner was involved in discussions around care and continuity of caregiver.

“When women were not listened to or believed by health care professionals during labor and birth, this resulted in frightening experiences for women and their safety being put at risk.”

Professor Heazell added, “However, there is still work to do. Service users need to feel heard, involved in and reassured by their care. To this end, the communication between health care professionals and service users is critical.

“We suggest maternity staff may benefit from additional training to discuss the reasons for and results of interventions to reduce the risk of pregnancy complications.

“This will need to be combined with effective communication skills to ensure that service users receive information to make an informed choice, ensuring they retain agency and perceived control.

“And that will enable the core recommendations of SBLCBv2 to be personalized to individual service users, promoting safe maternity care and improved maternity experience.”

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