2022 Maternity survey

Subgroup analysis

NHS Patient Survey Programme

Independent analysis for England published: January 2023

Subgroup analysis

We looked at how different groups of women rated their experience by using a multi-level model analysis. Subgroup analysis compares the average probability that different subgroups of women select the most positive answer to a survey question.

The subgroups used in the analysis were: age, named midwife status (inferred from responses to two questions: B6 for antenatal care and F4 for postnatal care),1 Please note, this does not mean that these women saw the same midwife for both antenatal and postnatal care, though they might have done. parity (whether women have had a previous baby or not), type of delivery (question C1), stirrups usage (question C11), ethnicity, religion, sexual orientation, long-term conditions, Indices of Multiple Deprivation (IMD) decile2 The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation in England. This ranks neighbourhoods based on their deprivation and then divides them into 10 groups (deciles) based on their deprivation rank where 1 is the most deprived and 10 is the least deprived. and COVID-19 treatment variable.

The themes are a mixture of composites3 For analyses of composite themes featuring multiple survey questions, the modelled outcome was whether the respondent selected the most positive answers (‘top box‘) to all questions within the theme. (using more than one question) and individual questions. The themes and the question number(s) in the questionnaire are:

Respect for women-centred values, preferences, and expressed needs (B18, C21 and D6)

Feeding support	(E2 and E3)

Experience of induction	(C4, C5 and C6)

Mental health – antenatal (B11 and B12)

Mental health – postnatal (F11, F12 and F13)

Quality and provision of information and communication in hospital (C19, C23 and D5)

Availability of staff (C18 and D4)

Whether concerns were taken seriously during labour (C17)

Involvement in care – labour (C20)

Involvement in care – antenatal (B15)

involvement in care – postnatal (F1)

Confidence in staff caring for them in the antenatal period (B17)

Confidence in staff during labour (C22)

Confidence in staff caring for them in the postnatal period	(F9)

Information around COVID-19 restrictions (B5)

Whether women were left alone at a time that worried them (C16)

Methodology and interpretation

Results for each demographic subgroup were generated as estimated marginal means using a mixed effects model allowing for a binary outcome, featuring a random trust effect (an effect allowing clusters of observations to vary randomly) and fixed effects of measured demographic and care characteristic factors (effects measured at the individual level)4 For the analysis of the overall experience question, with responses from 0 (I had a very poor experience) to 10 (I had a very good experience) the mixed effects model instead allowed normally distributed responses. The modelled outcome was the approximately normally distributed 0 to 10 response. .

For analyses of single questions, the modelled binary outcome was whether the respondent selected the most positive answer (“top box”) for that question (i.e. selected most positive = 1; did not select the most positive = 0). For analyses of broader care themes, comprised of multiple survey questions, the modelled binary outcome was the probability the respondent selected the most positive answers (“top box”) to all questions within the theme (i.e. selected most positive answers for all questions = 1; did not select the most positive answers for all questions = 0).

The results generated by these analyses can be interpreted as: the average probability that people with this characteristic, controlling for other characteristics in the model, selected the most positive answer for the question (or where theme is more than one question, all questions).

In this report, subgroup differences are considered reportable where a demographic or care characteristic overall (e.g. age) is significantly associated with experience and where the estimated marginal mean for the specific subgroup (e.g. 16 to 26) is significantly different from the overall mean. For further technical information on the subgroup analysis please see the Quality and Methodology document.

The analysis modelled the responses of different subgroups by age, named midwife status (inferred from responses to two questions: B6 for antenatal care and F4 for postnatal care),5 Please note, this does not mean that these women saw the same midwife for both antenatal and postnatal care, though they might have done. parity (whether women have had a previous baby or not), type of delivery (question C1), stirrups usage (question C11), ethnicity, language questionnaire completed in, religion, sexual orientation, gender, long-term conditions, Indices of Multiple Deprivation (IMD) decile6 The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation in England. This ranks neighbourhoods based on their deprivation and then divides them into 10 groups (deciles) based on their deprivation rank where 1 is the most deprived and 10 is the least deprived. and COVID-19 treatment variable.

The following tables illustrate the findings of the subgroup analysis.7 n/a in the table means that a subgroup was not included in the analysis of a theme. Findings significantly above (B) or significantly below (W) average are shown for each subgroup category under each theme.

Note: no significant results were found for the COVID-19 treatment variable, gender identity or non-English speaking variable so these are not included in the summary table below.

W	Significantly worse than average experience
B	Significantly better than average experience
n/a	A subgroup was not included in the analysis of a theme
Respect	Feeding support	Experience of induction	Mental health - antenatal	Mental health - postnatal	Information in hospital	Availability of staff	Being taken seriously	Involvement - antenatal	Involvement - labour	Involvement - postnatal	Confidence - antenatal	Confidence - labour	Confidence - postnatal	Information about COVID	Left alone
Age
16 to 26	W	B	W
27 to 32
33 and over	B	W	B
Named midwife status
No named midwife	W	W	W	W	W	W	W	W	W	W	W	W	W	W	W	W
Antenatal and postnatal	B	B	B	B	B	B	B	B	B	B	B	B	B	B	B	B
Antenatal only	W	W	W	W	W	W	B	W
Postnatal only	B	B	B	W	B	W	B
Parity
Primiparous	W	W	W	W	W	W	W	W	W
Multiparous	B	B	B	B	B	B	B	B	B
Type of delivery
Vaginal	B	B	B	B	B	B	B	B	B	B	B
Assisted vaginal	W	W	W	W
Planned caesarean	W	B	B	B	B	B
Emergency caesarean	W	W	W	W	W	W	W	W	W	W	W	W	W
(continued)	Respect	Feeding support	Experience of induction	Mental health - antenatal	Mental health - postnatal	Information in hospital	Availability of staff	Being taken seriously	Involvement - antenatal	Involvement - labour	Involvement - postnatal	Confidence - antenatal	Confidence - labour	Confidence - postnatal	Information about COVID	Left alone
Stirrups usage
Delivered without stirrups	n/a	n/a	n/a	n/a	B	n/a	B	n/a	n/a	n/a	n/a
Delivered in stirrups	n/a	n/a	n/a	n/a	W	n/a	W	n/a	n/a	n/a	n/a
Ethnicity
White	W	W
Multiple ethnic groups	W	W	W	W
Asian or Asian British	B	B
Black or Black British	B	B	B	B	B	B	B	B
Arab or other ethnic group	W
Not known	W
Religion
No religion	W	B
Buddhist
Christian	B
Hindu
Jewish
Muslim	W
Sikh	B	B
Other
Prefer not to say	W	W	W	W	W	W	W	W	W	W	W	W
Sexual orientation
Heterosexual / straight	W
(continued)	Respect	Feeding support	Experience of induction	Mental health - antenatal	Mental health - postnatal	Information in hospital	Availability of staff	Being taken seriously	Involvement - antenatal	Involvement - labour	Involvement - postnatal	Confidence - antenatal	Confidence - labour	Confidence - postnatal	Information about COVID	Left alone
Gay / lesbian
Bisexual	W
Other	B
Prefer not to say
IMD decile
1 (most deprived)	B
2
3	B
4
5
6
7
8
9	W	W
10 (least deprived)	W
Long-term conditions
Autism or autism spectrum condition
Breathing problem, such as asthma	W
Blindness or partial sight
Cancer in the last 5 years
Deafness or hearing loss
Diabetes	W
(continued)	Respect	Feeding support	Experience of induction	Mental health - antenatal	Mental health - postnatal	Information in hospital	Availability of staff	Being taken seriously	Involvement - antenatal	Involvement - labour	Involvement - postnatal	Confidence - antenatal	Confidence - labour	Confidence - postnatal	Information about COVID	Left alone
Heart problem, such as angina	W
Joint problem, such as arthritis
Kidney or liver disease
Learning disability
Mental health condition	W	W	W
Neurological condition	W
Another long-term condition	W	W	W	W

Subgroup graphs

In the graphs below, significantly better than average experiences are highlighted in green. Significantly worse than average experiences are highlighted in orange.

Worse than average experience
Average experience
Better than average experience