Findings of the National Maternity Experience Survey 2020 Thank You!
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National Maternity Experience Survey Findings of the National Maternity Experience Survey 2020 Thank you! Thank you to all of the women who participated in Ireland’s first National Maternity Experience Survey. Without your overwhelming support and participation the survey would not have been possible. The survey ensures that your voice will be heard by the people who can change and improve maternity care in Ireland. By putting you at the centre of your maternity care, we can work to ensure that the needs and wishes of mothers and their babies are met. Thank you also to the staff working across all maternity services for contributing to the success of the survey, and in particular, for engaging with and informing women while the survey was ongoing. The survey was overseen by a national steering group and a programme board. We acknowledge the direction and guidance provided by these groups. Appendix 1 lists the members of these groups and the core project team. 19 participating maternity hospitals and units Letterkenny University Hospital Sligo University Hospital Mayo University Cavan General Hospital Hospital Rotunda Hospital Our Lady Coombe Women Portiuncula of Lourdes and Infants University University Hospital Hospital National Midland Maternity Regional Hospital Hospital University Mullingar Hospital Galway Midland Regional Hospital Portlaoise University Maternity Hospital Limerick St Luke’s General Hospital South Tipperary Wexford General Hospital General Hospital University University Hospital Kerry Hospital Cork Waterford University Maternity Hospital Births in October 2019 Women who had a home birth in October and Births in October and November 2019 also took part November 2019 Executive summary 19participating 3,204 maternity hospitals/units women responded out of an and home birth services eligible population of 6,357 Care while 7.4 out of 10 pregnant Care during 8.6 out of 10 labour and birth Care in hospital out of after the birth 7.5 10 Specialised 7.6 out of 10 care Feeding 7.8 out of 10 Care at home 8.3 out of 10 after the birth 0 2 4 6 8 10 Overall experience 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 15% 33% 52% women responded out of an eligible population of 6,357 Fair to poor, 0-6 Good, 7-8 Very good, 9-10 “The whole experience was very positive and thorough. The two midwives in the labour room were especially supportive.” “I feel help with breastfeeding, bottle feeding, expressing and pumping could be improved by hospital staff.” “GP visits and public health nurse were very helpful and informative. Nothing was too much bother.” “Mental health, how to cope with change. I did not expect to feel the way I did after leaving the hospital with my baby.” Executive summary The National Maternity Experience Survey offers women the opportunity to share their experiences of Ireland’s maternity services. The survey is part of the National Care Experience Programme — a joint initiative by the Health Information and Quality Authority (HIQA), the Health Service Executive (HSE) and the Department of Health. The National Care Experience Programme seeks to improve the quality of health and social care services in Ireland by asking people about their experiences of care and acting on their feedback. The survey reflects a commitment made in The National Maternity Strategy 2016-2026 to evaluate maternity care services from the perspectives of the women who use them(1). In addition, a number of survey questions reflected the key themes from The National Maternity Strategy 2016-2026, such as choice, promoting health and wellbeing, involvement in decision-making and being treated with respect and dignity. Nationally, 60% of women said that they were offered a choice of the type of maternity care they would receive. Most women said that they were offered public care and consultant-led private or semi-private care, while home birth, DOMINO and midwifery-led care were not as commonly offered. There was also variation across hospitals in relation to the types of maternity care offered. 65% of women who were offered a choice opted for public consultant-led maternity care. A more detailed analysis of the themes of The National Maternity Strategy 2016-2026 is provided in Chapter 4 of this report. 6,357 women who gave birth in October and November 20191 were invited to participate in the first National Maternity Experience Survey. In total 3,204 women took part in the survey, resulting in a response rate of 50%2. The survey questionnaire contains 68 questions which capture the whole maternity pathway from antenatal care, through labour and birth, to postnatal care in the community3. The National Maternity Experience Survey includes questions taken or adapted from a library of questions developed by the National University of Ireland, Galway (NUIG) in collaboration with the National Care Experience Programme. Over 250 1 In order to ensure a sufficient sample size, women who gave birth in October and November in smaller maternity units were invited to take part. In larger maternity units women who gave birth in October only were invited to take part. More information and a breakdown of the relevant units can be found in Appendix 2. 2 It is important to note that the Covid-19 pandemic may have had an impact on the number of survey responses received. However, the women who were invited to take part gave birth prior to the pandemic and the maternity care they received was thus unlikely to have been affected. 3 The full National Maternity Experience Survey questionnaire can be found in Appendix 5. 6 National Maternity Experience Survey 2020 people, including women who had recently used maternity services, women’s representatives, midwives, public health nurses, GPs, obstetricians, policymakers, data analysts and academics were involved in developing and selecting the questions most relevant to the Irish context. The aim of the survey is to learn from the experiences of women to improve the safety and quality of the care that they and their babies receive. HIQA, the HSE and the Department of Health have committed to acting on the findings of the National Maternity Experience Survey to improve the quality of maternity care services in Ireland. Quality improvement plans will be developed by the HSE at national and local levels to address the issues highlighted in the survey. What were the main findings of the 2020 survey? Most of the women who responded to the survey had a positive experience of maternity care. In total, 85% of participants said that they had a good or very good overall experience. The majority of the women who responded gave birth to one baby, and for 42% this was their first baby. For 87% of women, their GP or family doctor was the first healthcare professional they saw when they thought they were pregnant. In relation to the higher-scoring questions on the survey, most women said they were treated with respect and dignity, and had confidence and trust in the staff that cared for them, both in community care settings and in maternity units and hospitals. Participants made thousands of positive comments about their experiences of midwives and other members of staff. Nevertheless, there were a number of areas where women identified opportunities for improvement. While most women said that they had a positive maternity experience, 15% said their experience was ‘fair to poor’. The lower-scoring questions on the survey primarily related to the period shortly after birth. A number of women were not given the opportunity to ask questions nor were they as involved as much as they wanted to be in decisions about their care after the birth. Some did not receive sufficient physical and emotional support when they needed it during this time. When asked to describe their experiences in their own words, a number of women said that hospital staff were very busy and not always able to assist them when they needed it. Additionally, many women felt they did not receive sufficient information and support for their mental health, not just in the period after birth, but also during their pregnancy. There were some significant differences between the experiences of women from different groups. For example, women who had previously given birth were more likely to have a positive experience. 60% of women said that they were offered a choice of the type of maternity care they would receive, and women who chose to have a home birth reported more positive experiences than women who gave birth National Maternity Experience Survey 2020 7 in a maternity unit or hospital. However, the number of women who had a home birth was small so it is difficult to make reliable comparisons. There were differences between the scores received by maternity units or hospitals but in general these differences were relatively small, with most scoring close to the national average for each stage of care. There were also differences by participants’ county of residence, with women living in Monaghan reporting the most positive overall experiences of maternity care, for example. A summary of how women described their maternity experiences, followed by the results for each stage of care along the maternity care pathway, are presented below. In their own words: How participants described their experiences Participants made 6,075 comments in response to the three free-text questions in the survey. These comments give a detailed account of women’s experiences throughout their maternity care journeys. The majority of the positive comments relate to staff and the care and support that they provided. When asked about areas for improvement, women mostly commented on staffing levels, communication and issues relating to feeding their babies.