The Future of Maternity Care: Overcoming Challenges and Embracing Opportunities

Maternity care services are a fundamental pillar of the NHS, directly influencing the well-being of mothers, babies and their families.

However, it is a fact that maternity services are stretched. This is depicted in the growing number of new mothers reporting some kind of poor experience with the care they received throughout their Antenatal, Labour and Postnatal care journey. The 2024 NHS Maternity Survey results, which collected responses from 18,900 new mothers who gave birth in January and February 2024, provide important insights into the current state of maternity care. While progress has been made in some areas of care, the findings show that there are still a number of significant barriers to overcome.

The survey highlighted a significant, gradual improvement in mental health support during pregnancy. A notable improvement has been recorded in both midwives asking about women’s mental health providing support when needed. Almost four out of five women reported being asked about their mental health, a gradual increase of 9% since 2019. Nine out of ten respondents said they were supported with their mental health, a 6% increase since 2021. These results align with recent policy initiatives emphasising the importance of holistic, person centred care in maternity services, including enhanced mental health support for expectant and new mothers¹.

However, while these improvements in mental health support are encouraging, the survey reveals areas where maternity care falls short and demands urgent attention. The 2024 results show a significant decline in the quality of services and responsiveness of the maternity staff throughout the maternity journey. Over the past five years, the percentage of women who reported always receiving help when they needed it during labour and birth has fallen by 8%. Alarmingly, only three out of five women said that they always got help when needed. This is a worrying indicator that not only affects patient experience but, most importantly, raises significant concerns about safety that could jeopardise the well-being of both the mother and baby.

Women’s involvement in decision-making is another area that has been highlighted as requiring improvement. While 80% of women said that they were always involved in decisions about their antenatal care, 75% and 72% were involved in decisions about their labour and birth and postnatal care, respectively. However, only 59% said that they were definitely involved in the decision to be induced, a critical decision which should be made collaboratively, with women fully informed and actively engaged in decisions about interventions.

It is not a surprise that this year’s results confirmed the continuous decrease in confidence and trust of the maternity staff across all three phases of maternity care. Over the past five years, the number of women who reported that they definitely had confidence and trust in the staff caring for them during labour and birth fell from 84% to 77%, while the proportion of those definitely having confidence and trust in the staff they spoke to after returning home fell from 73% to 69%.

The challenges outlined in the 2024 Maternity Survey confirm the need for addressing systematic issues and constraints such as staffing and resourcing strategies, as these have already been highlighted in recent publications . Most importantly, they call for action towards a more patient-focused strategy. Picker’s person centred care approach provides a roadmap to overcome these barriers by ensuring that maternity services prioritise respect of individual needs and preferences, clear communication and information provision, and involvement in decision-making of mothers and their families.

The decline in the responsiveness of the maternity staff, as underscored in the survey findings presents a challenge with a direct impact on both patient experience and safety. Picker’s principles emphasise the critical role of emotional support and physical comfort in delivering high-quality care. This calls not only for adequate resources but additional training in empathetic communication and active listening to foster an environment of support and reassurance during women’s vulnerable moments. By embedding such practices, maternity services can rebuild trust and confidence while prioritising the well-being and safety of mothers and babies.

Furthermore, the declining confidence and trust in maternity staff is another worrying trend that requires further consideration. This depicts broader systemic issues relating to inconsistencies in care and lack of continuity. Continuity, coordination, and smooth transition, as advocated by Picker, can offer a clear approach to this challenge. Continuity of carer, by assigning the same midwife during antenatal care, can help increase trust, as women would be more likely to build meaningful relationships with their midwives over time. Additionally, building clear communication lines of support during postnatal care, as women could feel vulnerable after returning home, can help address the decline in trust after discharge and increase confidence in the system as a whole.

The 2024 survey provides a clear assessment of the challenges in maternity care and an opportunity for change. Investing in practices of person centred care seems essential to improve maternity care experiences. Positive relationships embedded in emotional support, empathy, respect, clear communication, and accessible information are empowering tools for patients and staff. Such a holistic approach can also ensure that mothers and babies receive safe, respectful, personalised, high-quality care at every stage of their journey.

References

¹National Maternity Inspection Programme (NMIP), September 2024.