This survey looked at the experiences of women who had a live birth in early 2021.
Women who gave birth between 1 and 28 February 2021 (and January if a trust did not have a minimum of 300 eligible births in February) were invited to take part in the survey. Fieldwork took place between April and August 2021. This was during the third national lockdown for the COVID-19 pandemic. This means that respondents will have gone through their antenatal, labour and birth, and postnatal stages under pandemic conditions. Therefore, results of this survey reflect experiences of care throughout the COVID-19 pandemic.
The 2021 maternity survey was also the first mixed-mode maternity survey in the NHS Survey Programme, where women were encouraged to respond online (but were also given the option of postal completion).
Responses were received from more than 23,000 women. The response rate increased substantially, from 36% in 2019 to 52% in 2021, with 89% of women taking part online.
What we found
In previous surveys, the picture of maternity care in England has been one of year-on-year improvement. This year, we have seen a change in direction and results have declined in many areas. This is likely reflecting the impact that the COVID-19 pandemic had on services and staff. Results show that areas particularly affected were involvement of partners, choice, information provision and staff availability. Despite the pressures of the pandemic, the majority of women continued to report positive experiences of maternity care, particularly during their labour and birth.
Continuity of carer
We found statistically significant improvements since 2019 in questions asking about continuity of carer. Forty-one per cent of women said they saw or spoke to the same midwife every time during their antenatal check-ups, up from 37% in 2021. Postnatally, 30% said they saw or spoke to the same midwife every time, up from 28% in 2019.
Mental health support
Sixty nine percent of women said that during their antenatal check-ups, the midwife asked them about their mental health. Postnatally, 95% said that the midwife or health visitor asked them about their mental health. Most women (83%) said that if they needed this, they were given enough support for their mental health during their pregnancy.
The majority of women continued to report positive experiences about their interactions with staff. For example, 86% of women said they were ‘always’ spoken to in a way they could understand during their antenatal care; 85% said that they were ‘always’ treated with respect and dignity during labour and birth and 71% said that they were ‘always’ treated with kindness and understanding while in hospital after the birth.
Key areas for improvement
In line with findings we have reported in previous maternity surveys, results continued to show poorer experiences of care for many women postnatally compared with other aspects of the maternity pathway. This aspect of care in particular has worsened during the pandemic, with the results for several questions showing statistically significant declines. For example, 34% of women said they would have liked to have seen a midwife ‘more often’ during their postnatal care compared with 25% in 2019; and 55% of women who needed it said that in the six weeks after the birth of their baby, they ‘definitely’ received help and advice from a midwife or health visitor about feeding their baby, down from 62% in 2019.
How experience varies for different groups of people
Women who had continuity of carer, women who have had a previous pregnancy and women who had an unassisted vaginal birth consistently reported better experiences. Women who have a caesarean birth (emergency and elective) and women who have a mental health condition consistently reported poorer experiences.
Results for NHS trusts
Each trust has been provided with a benchmark report, which provides: detail of the survey methodology, headline results, the trust score for each evaluative question, banding for how a trust score compares with other trusts and historical data (where available).
Results from previous surveys
How will results be used?
We will use the results from the survey in the regulation, monitoring and inspection of NHS trusts. Survey data will be used to help us assess how trusts are performing. Survey data will also form a key source of evidence to support the judgements and inspection ratings published for trusts.
Trusts and commissioners are expected to take action to improve services based on the results.
NHS England and NHS Improvement; and the Department for Health and Social Care
Information collected nationally in a consistent way is essential to support public and Parliamentary accountability. The results are used by NHS England and NHS Improvement; and the Department of Health and Social Care for performance assessment, improvement and regulatory purposes.