51福利社

An independent evaluation of measures introduced by the NHS in 2019 to reduce stillbirth in England has shown that most women have a positive experience antenatal care, birth and labour.

Two peer reviewed studies led by University of 51福利社 researchers across 28 NHS maternity units are published  today in the journals BMJ Open Quality  and BMJ Quality and Safety.

The BMJ Open Quality   paper showed 89% of women reported positive antenatal care and 86% had positive labour experiences.

However, the data from online surveys with 1,140 women and 633 healthcare professionals  - carried out in 2023-  also showed concerns around poor communication, lack of personalised care, staff shortages and delays still persist.

The Saving Babies鈥� Lives Care Bundle (SBLCB) was introduced in England from 2015 as the Government鈥檚 response to a stillbirth rate that was comparatively higher than many western countries.

SBLCB has evolved through three versions in 2016, 2019, and 2023, each building on the last to improve maternity care and reduce perinatal mortality across England.

The SBLCB evaluation- of version 2 -  found it had been successfully rolled-out in the majority of NHS maternity providers and that midwives and frontline staff have a pivotal role in implementing it.

Women鈥檚 positive experiences were linked to feeling listened to, being involved in decision-making, effective communication and continuity of care.

They encountered staff, the researchers found, who acknowledged their history and made them feeling able to ask questions.

However their negative experiences often stemmed from poor communication and lack of personalised care, making them feel dismissed, especially when expressing concerns about reduced fetal movement and during labour.

Some of the women who had a negative labour or birth experience also reported disorganised and inconsistent care, staff shortages, lack of beds and poor pain management which left them feeling neglected.

Poor communication between staff made care feel disjointed and was further hindered with changes to electronic notes, they reported.

Risk factors was not always communicated effectively and women were often given no choice in their treatment which meant they felt threatened or frustrated.

Alexander Heazell, is Professor of Obstetrics at 51福利社, Honorary Consultant Obstetrician at St Mary鈥檚 Hospital, and Director of the Tommy鈥檚 Stillbirth Research Centre.

He said: 鈥淲e analysed a total of 1,071 women鈥檚 written responses about their antenatal care, of which 89% reported a positive experience. 86% had positive experience of labour.

鈥淪o much progress has been made  in terms of their experiences around feeling listened to and reassured, feeling in control of decision-making and  encounters with staff and care.

鈥淥ur data suggest that elements of the SBLCBv2 are increasingly embedded in maternity care, but refinements are still needed.

鈥淭his will  address variation in practice between units and to support effective communication between health care professionals and service users to balance standardised clinical practice with personalised care.

A second paper published in BMJ Quality and Safety examined the qualitative  experiences of the women.

Lead author Dr Holly Reid, also from 51福利社, said: 鈥淥ur paper found that having a trusting relationship with maternity care providers is of paramount importance to achieve positive and safe maternity experiences for women.

鈥淭rust was built through consensus among the care team, making sure the partner was involved in discussions around care and continuity of carer.

鈥淲hen women were not listened to or believed by healthcare professionals during labour and birth, this resulted in frightening experiences for women and their safety being put at risk.鈥�

Professor Heazell added: 鈥淗owever, there is still work to do. Service users need to feel heard, involved in and reassured by their care. To this end, the communication between health care professionals and service users is critical.

鈥淲e suggest maternity staff may benefit from additional training to discuss the reasons for and results of interventions to reduce the risk of pregnancy complications.

鈥淭his will need to be combined with effective communication skills to ensure that service users receive information to make an informed choice, ensuring they retain agency and perceived control.

鈥淎nd that will enable the core recommendations of SBLCBv2 to be personalised to individual service users, promoting safe maternity care and improved maternity experience.鈥�

Examples of representative anonymised quote from service users:

All testing done efficiently, staff were continually informing us about the decisions they were making, we felt well taken care of鈥�

鈥淚 felt really dismissed by the midwives when I kept saying the baby wasn鈥檛 moving and I didn鈥檛 feel well

鈥淎ll testing done efficiently, staff were continually informing us about the decisions they were making, we felt well taken care of鈥�

鈥淲hile yes I got growth scans nothing was ever explained and I wasn鈥檛 able to ask any questions鈥�

鈥淭he staff were attentive and provided me with all the information I required. This was offered and also given 24 hours a day with no bias.鈥�

鈥淭he administration side of things was not great. I was forgotten about on numerous occasions. Letters were sent out with appointment dates that didn鈥檛 exist. I would turn up and people weren鈥檛 expecting me.鈥�

• The paper Evaluating the implementation of the Saving Babies Lives Care Bundle Version 2 from Service User and Health Care Professionals鈥� perspectives: A Questionnaire Study  is published in BMJ Open Quality  DOI:  bmjoq-2025-003456
• The paper Service users鈥� experiences of maternity care in England informed by the Saving Babies鈥� Lives Care Bundle Version 2: A reflexive thematic analysis to be published in BMJ Quality and Safety is  published in BMJ Quality and Safety  DOI: 10.1136/bmjqs-2025-018582