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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 1; 335(7630): 1112.
PMCID: PMC2099505

More than four in 10 women were not offered the choice of a home birth, report says

Pregnant women in England are not being offered the choice and care laid down in national guidelines, a survey of new mothers shows.

The survey, which was carried out by the Healthcare Commission, showed that women are generally fairly happy with maternity services. Overall the percentage of women who said that their care was excellent, very good, or good was 89% during pregnancy, 90% during labour and birth, and 80% after the birth.

But the commission said that in some areas the feedback from women was less positive and that there was wide variability in satisfaction between trusts.

More than four in 10 women were not offered the choice to have their baby at home, as recommended in guidelines from the National Institute for Health and Clinical Excellence (NICE). But while the percentage who were not given this option was as low as 8% in some trusts, in others it was 76%.

A similar proportion of women (36%) were not offered NHS antenatal classes, which the government said trusts should do in its national framework for children, young people, and maternity services. But again in some trusts this figure was 76%.

The survey, which was carried out in trusts in England and completed by 26 000 women who gave birth in January and February this year, also found that more than a quarter of women (26%) were left alone during labour or shortly after giving birth at a time that worried them. And more than half (57%) said that they had been lying down when giving birth or that stirrups had been used—practices that are discouraged in NICE guidelines.

Most women said they were treated with kindness and understanding, although at one trust 18% of respondents to the survey said this was not their experience.

In terms of aftercare more than 30% of women looked after in 21 trusts (of a total of 148) said they did not get enough food. Overall 22% of women said they would have liked to have seen a midwife more often after birth, and 19% said that the toilets and bathrooms at the hospital were “not very clean” or “not clean at all.”

Anna Walker, chief executive of the commission, said, “Overall, women are clearly positive about maternity services. But the results do highlight specific areas of concern and wide variations with issues, including postnatal care, communication, food, and cleanliness.

“These results show us that many trusts provide very positive services for women. Trusts with less positive results need to learn from the good performers.”

The commission is due to publish detailed results of its comprehensive review of maternity services early next year, including data on outcomes, facilities, resourcing, staffing, and costs. The results from this survey will contribute to the review. All trusts will be ranked on a four point scale from “excellent” through to “weak.”


Women's Experiences of Maternity Services in the NHS in England is at

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