A national survey of mothers' experiences shows they are being given more flexible maternity care - but there is still room for improvement.

Care during pregnancy, labour and.birth and.post-natal treatment have become.more flexible and responsive to the needs of women in the last 10 years. However, according to the findings of a major national survey of recent mothers published by the National Perinatal Epidemiology Unit at the University of Oxford, there are important aspects of care that still do not follow national policy and standards and do not fully meet women's expectations from the service.

For example, although almost half of the women surveyed had antenatal care provided exclusively by midwives, only a minority of women directly accessed a midwife when they became pregnant, despite this being national policy since 2004..

The survey was.funded by the Information Centre for health and social care, the Healthcare Commission and the Department of Health. Nearly 3,000 recent mothers across England responded to the survey in March 2006, giving their views on the care and information they received through pregnancy, birth and post-natally, in hospital and at home. Changes since 1995 are examined, together with comparisons of the experiences of first-time mothers and those who already have children. The survey.builds on the last national survey of this type conducted for the Audit Commission in 1995 and analysed by the NPEU.

According to the findings, more than one-third of women questioned.only had the option of going to one hospital for the birth of their baby, but the number being offered home births has risen significantly since 1995, with more than one in three now saying that they had this option at the start of pregnancy.

The survey also indicates that the caesarean section rate has risen from 17 per cent in 1995 to 23 per cent in 2006. Less than two per cent of these women stated that they had chosen to have a caesarean, without indicating any clinical reasons.

Personal care

Care from doctors and midwives was praised by the vast majority of the women surveyed, although around one-quarter had mixed views about the care they received and were not wholly positive..

Around one in 10 women felt that staff did not communicate well with each other during labour and birth, and while most women described their carers at this time as 'supportive' and 'kind', 16 per cent indicated that the staff were 'rushed'.

One section of the report examines the care received by four specific groups, women from black and minority ethnic backgrounds, BME women born outside the UK, women living in the most deprived areas and single women. These findings suggest that women from these groups were more likely to access maternity services later in their pregnancy, more likely to report feeling they were not always treated with respect by their carers and that they were not always spoken to in a way they could understand compared with other women.

Maggie Redshaw, from the NPEU and.one of the report's authors, said: 'By collecting data on clinical care, as well as on women's individual experiences, we have been able to provide a more complete picture of women's perspective on care in pregnancy and childbirth.

'Maternity care workers, policy-makers, commissioners and health professionals can reflect on the findings of the survey, which come directly from mothers themselves.

'This survey gives a message to those designing services and caring for women during the birthing process that they are in a powerful position to make a difference to that care.'

The report identifies the following.key goals for the delivery of maternity services for women in the future:

  • easy access to midwives as first pregnancy contact;
  • antenatal education and support of the quality women need;
  • information to ensure women can access appropriate sources including health professionals and be informed about their care in the wider context of pregnancy and childbirth;
  • staff working with women during pregnancy, labour, birth and post-natally to have appropriate interpersonal skills and support to facilitate more individual care;
  • responsive and flexible post-natal care and support available to support breastfeeding, infant care and self care - and more broadly in relation to practical baby care.

The findings will provide a baseline for future change and a national point of comparison. They.will be used by the NPEU in future research work on quality and outcomes of maternity care in England.