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Understanding patterns in maternity care in the NHS and getting it right

BMJ 2013; 346 doi: (Published 01 May 2013) Cite this as: BMJ 2013;346:f2812
  1. Lucy C Chappell, clinical senior lecturer in maternal and fetal medicine1,
  2. Catherine Calderwood, national clinical director for maternity and women’s health, NHS England 2,
  3. Sara Kenyon, senior lecturer3,
  4. Elizabeth S Draper, professor of perinatal and paediatric epidemiology 4,
  5. Marian Knight, National Institute for Health Research professor in public health 5
  1. 1Women’s Health Academic Centre, King’s College London, London SE1 7EH, UK
  2. 2NHS England, PO Box 16738, Redditch, UK
  3. 3School of Health and Population Sciences, University of Birmingham, Birmingham, UK
  4. 4Department of Health Sciences, University of Leicester, Leicester, UK
  5. 5National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  1. lucy.chappell{at}

It’s important to choose the right indicators, use high quality data, and engage all stakeholders

This week, the Royal College of Obstetricians and Gynaecologists published its report on patterns of maternity care in English NHS hospitals during 2011 to 2012.1 The stated aim was to “examine the validity of potential performance indicators, and to determine how successfully these could be used to compare performance between maternity units using available data.” Data from inpatient admissions and day cases collected routinely from English NHS trusts through Hospital Episode Statistics (HES) were analysed to provide an initial 11 performance indicators, all related to intrapartum care (box). The report presents the data as risk adjusted estimates for each maternity unit within a funnel plot showing the national mean. If variation occurred at random, only one in 20 or one in 500 units would be expected to lie outside the limits representing two (inner funnel limits) or three (outer limits) standard deviations, respectively.

Indicators chosen for inclusion in the report

  • Induction of labour rate

  • Proportion of induced labours resulting in emergency caesarean section

  • Proportion of spontaneous labours resulting in emergency caesarean section

  • Elective caesarean section rate

  • Proportion of elective caesareans performed before 39 weeks of gestation without clinical indication

  • Instrumental delivery rate

  • Proportion of instrumental deliveries carried out by vacuum extraction (vacuum to forceps delivery ratio)

  • Proportion of attempted instrumental deliveries resulting in emergency caesarean section

  • Third and fourth degree perineal tear rate after unassisted vaginal delivery

  • Third and fourth degree perineal tear rate after assisted vaginal delivery

  • Emergency maternal readmission within 30 days of …

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