More than a third of pregnant women in England do not always get help from maternity staff during labour or childbirth, the NHS care regulator has found.

Even more – almost half – do not always get help when they are in hospital after giving birth, a Care Quality Commission (CQC) survey of almost 19,000 women’s experiences of maternity care found.

A significant minority of women do not have confidence in the staff who look after them when they are receiving antenatal care (30%), during their labour and birth (23%) and after they have delivered their child (31%), the research also shows.

In addition, one in seven do not get the pain relief they feel they need during labour and birth and a quarter are unable to ask staff questions after their baby’s birth.

The worrying findings underline the already acute concern about the quality of care provided by NHS maternity services in England, many of which the CQC has deemed to be unsafe.

In September, Wes Streeting, the health secretary, said: “The crisis in our maternity services … is one of the biggest issues that keeps me awake at night.” He also warned of the risk of “disaster greeting women in labour tomorrow” and that problems existed in hospitals across England.

Many of the metrics the CQC uses when seeking women’s views about maternity care have got worse over the five years since the annual survey began, it said.

For example, just 64% of this year’s participants – who gave birth in February – felt they could always get help during labour and birth, down from 72% in 2019. Women’s trust in staff at each stage of pregnancy has also fallen.

“It is disappointing that for some women the care they received fell short of expectation and that trust in staff has fallen.

“There has been decline in those able to get enough help and support during labour and birth, in access to pain relief while in labour and the availability of information and support after giving birth,” said Nicola Wise, the CQC’s director of secondary and specialist care.

Joanna Corfield, of the NCT parenting charity, said: “Failing trust, confidence and timely support – this cycle of maternity failings must end now.” Safe, compassionate and equitable care must be “non-negotiable” for every woman, she added.

Staff shortages are a key reason women do not always get the help they need, the Royal College of Midwives said. Midwives “often struggle to give the high standard of care they want”.

More positively, the CQC also found that more women are receiving support with their mental health from maternity staff. One in five mothers develop a psychological problem related to their pregnancy or birth.

For example, 76% of mothers-to-be were asked about their mental wellbeing at antenatal checkups and most said a midwife had done the same during their postnatal care.

Even larger numbers said midwives always listened to them (83%) and they were always treated with respect and dignity (87%).

Kate Brintworth, NHS England’s chief midwifery officer, said: “Mental health support is vital during pregnancy and it’s encouraging that mothers are saying their experiences in this area have improved.

“But we know there is much more to do to ensure all women and babies receive high-quality personalised care.”