Next week I'm off to talk to commissioners of maternity services about online feedback from users of the services they commission.

Maternity care is one of those parts of health care where "clinical outcomes" are vital but usually OK, and "experiential outcomes" sometimes forgotten. I've blogged before on what women have said on Patient Opinion about their care.

So I thought it might be interesting to construct a quick Wordle of the 1,000 odd comments on maternity care that we can find on both Patient Opinion and NHS Choices. And here it is.

Yesterday the London Evening Standard ran a story on the "nightmare" of maternity care in London, prompted by stories women have shared on Patient Opinion about their bad experiences of giving birth.

For example, Maree calls her experience of childbirth "terrifying, confusing and demeaning". Anonymous 2 found "the showers were flithy and paint was peeling off the wall" where she gave birth. Anon reported "cockroaches in the communal eating area". And today on Patient Opinion, Sam told how she feels that her experience has left her not with post-natal depression, but with post traumatic stress disorder.

To be sure, we hear plenty of stories of extraordinary care too. Often, these too will move us to tears.

But that's not the point. The point is that plenty of women are saying, very clearly and courageously, that their experience simply wasn't good enough - and, in some cases, was actually harmful.

The point is: 15 years after the Changing Childbirth report, surely we can do better than this?

The NHS is in the news again today, this time its a report by the Healthcare Commission on maternity care that's got them all buzzing.  The report was commissioned after a series of separate investigations into deaths at maternity hospitals revealed similar problems.The report claims that many maternity units in England are failing to provide top quality care.  It states that:
“Most women giving birth in early 2007 whom we surveyed had a favourable view of the care that they received. For labour and childbirth, 89% rated their care as “good” or better, falling to 80% for the care they received after birth and at home. These figures, however, conceal significant differences between trusts; in the trust with the least favourable results from the survey only 67% of mothers reported their care during labour and birth as good or better, compared with 96% in the trust with the most favourable results.” Page 5 Healthcare Commission Towards better births: A review of maternity services in England July 2008

So there’s a huge difference in the level of care between trusts.  And different levels of choice as well…according to the report, while the majority of women have some degree of choice, such as a midwife-led unit, or a home birth, two-thirds of trusts could currently offer only a consultant-led service in its hospitals.   In 1995, the government pledged that by 2009, all women would have a choice of birth location.  According to the BBC, , midwives have said ministers would struggle to meet this promise.

As for the key findings of the report, these are:

• Levels of staffing were well below the average, indicating that they may have been inadequate. (Many of the maternity reports on Patient Opinion, even those saying thanks, indicate that staff were often "very busy").
• Consultant obstetricians did not spend the time recommended by their professional body on labour wards.
• Doctors and midwives did not attend in-service training courses consistently across trusts.
• There was not adequate continuity of care for women.
• Recommendations were not adequately adhered to for antenatal care, particularly for those women whose pregnancies were likely to be more risky.
• Women experienced poor communication, care and support after their babies were born.
• There were too few beds and bathrooms, particularly in labour wards.
• Inadequate systems for IT and data prevented efficient management of the maternity service, even among some of the larger and well-respected trusts.

Maternity Care ratings published in the Telegraph in January this year show the trusts which received ratings of Best performing, Better performing, Fair performing and Least well performing.  And the healthcare commision have made it easier to see the rating of local hospitals.

But it’s not all about the ratings. Where some stories like this one relate to a least well performing trust, others like this one come from a trust deemed to be best performing.  Stories of great care like this one from a fair performing demonstrate that perception of good care is also about dignity, respect and consideration shown to babies and new mothers.

The reports recommendations relate to monitoring standards of care; ensuring that there is sufficient staff; encouraging team working; training staff and keeping skills up to date; collecting information on outcomes; meeting the requirements of women from higher-risk groups.  One recommendation in particular caught my eye though. 

“Trusts and those commissioning services should ensure that there are regular and effective mechanisms for gathering and acting on the views of women using their services, and should ensure that they are represented in the process for planning and monitoring the quality and safety of service provided. “ page 6

Trusts only need to read, respond to and act on the stories, concerns and thanks available on Patient Opinion to see how their services can be improved.  Lets hope they follow that recommendation.