Maternity services are "just not good enough" and too many women have "truly shocking" experiences despite recent improvements in the care mothers receive before, during and after giving birth, the NHS regulator warned on Thursday.
One in four women are left alone during their labour or birth and find that worrying, according to a survey of women's experiences of NHS maternity care in England conducted by the Care Quality Commisison (CQC). That has increased from the 22% who said the same when the CQC last investigated the issue in 2010.
About one in four women also felt that they did not receive pain relief such as an epidural either quickly enough or in a strong enough dose to help alleviate their pain. Almost one in five (19%) of the 23,000 participants, who all gave birth during February at an NHS hospital, midwife-led unit or birth centre, or at home, said that concerns they had during labour and birth were not taken seriously.
Almost one in 10 (9%) thought the toilets were not clean enough, while some women voiced anger and distress at feeling "bullied" and pressurised by midwives and nurses to breastfeed their baby, and made them feel isolated and guilty if that did not happen.
Professor Sir Mike Richards, the CQC's chief inspector of hospitals, said he was encouraged by some notable improvements in maternity care since 2010, for example that the proportion of women who had trust and confidence in staff had risen from 73% to 78%.
But overall too many women still were not getting the care they should, he added. "In too many cases, the quality of care delivered is just not good enough. Women and their partners are being left alone when it worries them, toilets and wards are described as unclean, and some women are not given the pain relief they had expected or planned to use in their birth plan", said Richards.
"Feedback in the comments shows at times a truly shocking picture of experiences that should be the most joyous time in a woman's life, not the most frightening", Richards added.
Cathy Warwick, chief executive of the Royal College of Midwives, said the report contained too many "worrying findings" and warned that the NHS is 4,800 midwives short of the number it needs to deliver the best possible care.
"It is sad to see that in three years the NHS has not improved in terms of women seeing the same midwife during their care, which often means women have to repeat their histories over and over again," said Warwick.
"This third survey shows that the NHS continues to fail too many women. It sets out yet more evidence of the real-life and disheartening effects on women of the shortage of midwives. How many more flashing red lights do we need? I am deeply disappointed about the high proportion of women who were left alone and worry about this during early labour. It is sad, too, that vital postnatal care is a focus for women's criticisms. We urgently need to change these things."
London remains the area of England with the worst-perceived maternity care, confirming a trend revealed by the previous survey.
After analysing the responses from the 23,000 women the CQC said that nine hospital trusts provided "consistently better" maternity care, but that seven offered mothers "consistently worse than average" care. Six of those seven were in the capital, including the Homerton hospital in east London, Lewisham hospital in south-east London, Croydon in south London and the Barts health trust, which runs four main hospitals in east and north-east London.
