NCT believes maternity services should meet the needs of their local community.

In a Spotlight on Research article, guest editor Rachel Plachcinski looks at a Cochrane Review on women being offered midwife-led continuity models of care.

NCT resources include a range of articles, policy briefings and document summaries:

Midwifery care is vital for quality maternity services
Innovative integrated and in the interest of families: the maternity network approach 
Improving the maternity experience of Irish travellers
Too few women offered choice in maternity care
Putting mothers first
A better model of care for high-risk mothers
The role of GPs in maternity care - what does the future hold?
Support overdue: women's experiences of maternity care

Responsibility for healthcare is devolved from the Westminster government to the Scottish Parliament, the Welsh Assembly and Northern Ireland Assembly and each government has its own policy documents.

This page provides the policy frameworks for maternity and transition to parenthood services throughout the UK and for England, Scotland, Wales and Northern Ireland.

United Kingdom

Midwifery 2020 aims to develop an informed vision of the contribution midwives will make to quality and cost effective maternity services throughout the UK. The report Midwifery 2020: delivering expectations published in 2010 is the outcome of discussions and contributions from midwives, managers, members of the maternity team, educationalists, commissioners and services users with regards to the future of midwifery.

Standards for Maternity Care Report of a Working Group was published in 2008 by the Royal College of Obstetricians and Gynaecologists (RCOG) with the Royal College of Midwifes (RCM), the Royal College of Anaesthetists (RCA) and the Royal College of Paediatrics and Child Health (RCPCH). It is applicable across the UK and contains 30 individual standards for care for the maternity care pathway from ‘preconception’ to the ‘transition into parenthood’ in one document, developed from 50 original source documents. The standards for intrapartum care have been taken directly from Safer Childbirth, published in 2007. Each standard is supported by audit indicators which are also published in a separate slimmer document.

Funding and performance of healthcare systems in the four countries of the UK before and after devolution published in January 2010, is a longitudinal analysis of the four countries 1996/7, 2002/3 and supplemented by a cross-sectional regional analysis of England 2006/7. The report underlines the fact that the four countries have taken very different paths in healthcare since devolution, and shows that it is far from clear that they all offer an equal benefit to patients in return for taxpayers' investment. It offers, for the first time, comparisons of healthcare in Scotland, Wales and Northern Ireland with the English regions, with which they share much common ground. Particular areas of interest to NCT are figures relating to Midwifery staffing throughout the four countries of the UK, as well as admissions and appointments per staff member with breakdown of figures throughout the SHAs regions of England, and Northern Ireland, Wales and Scotland. Improvements in perinatal mortality and life expectancy from birth 1996-2006 are broken down into the ten Government Office Regions (GOR) of England and Northern Ireland, Wales and Scotland.

England

In 2016, the National Maternity Review in England report was published. The report found that the quality and outcomes of maternity services have improved significantly over the last decade, and gave key recommendations for further improvement of maternity services. In the September 2016 issue of NCT Perspective journal, senior policy advisor Elizabeth Duff describes her role on the National Maternity Review in England, and the importance given to the need for continuity of carer.

Three reports published in 2013 looked at the state of maternity services and the regulation of midwives. National Audit Office's Maternity services in England, the Parliamentary and Health Service Ombudsman's Midwifery supervision and regulation: recommendations for change and the Care Quality Commission's Maternity services survey. The findings of all three reports raise considerable concern about the state of maternity services and the regulation of midwives.

The NHS White Paper, Equity and excellence: Liberating the NHS, sets out the Government's long-term vision for the future of the NHS. It sets out the concept of maternity networks as a fresh approach to the structure of care for pregnant women and new families. NCT welcomes the idea of maternity networks.

Following on from its previous inquiry into the safety of maternity services, The King's Fund commissioned further research to answer a fundamental question: Can the safety of maternity services be improved by more effectively deploying existing staffing resources? Staffing in maternity units: getting the right people in the right place at the right time concludes that the key to improving maternity care is using midwives and other maternity staff more effectively. The report considers the available evidence about the relationship between staffing levels and deployment practices and safety of care for mothers and babies, focusing specifically on labour and birth. It sets out the policy background and the workforce issues currently faced by maternity services. It reviews evidence particularly on the relationship between staffing levels and outcomes, the potential for shifting tasks between various health professionals and making use of new and extended roles, the effectiveness of different models of care and the impact of these on use of resources.

Over the past 30 years, GPs have gone from being the main point of contact to someone who merely signposts women to midwife- or consultant-led care. This report, The role of GPs in maternity care - what does the future hold? An Inquiry into the Quality of General Practice in England 2010 suggests that, should GPs be trained so that they are adequately skilled to look after women safely, they could be more involved in antenatal care, particularly during the first trimester. This would require an urgent clarification of the GPs roles and responsibilities, as well as communication channels, within the multi professional maternity team. The Kings Fund does not recommend that GPs undertake intrapartum care. NCT’s document summary of this is available as a related document.

Delivering high quality midwifery care: the priorities, opportunities and challenges for midwives, published in 2009 by the Department of Health, reflected the policy direction of Maternity Matters (see below). An NCT document summary highlights the key points.

Maternity Matters is the previous government’s maternity care strategy for England and highlights the commitment to developing a high quality, safe and accessible maternity service through the introduction of a new national choice guarantee for women. An NCT document summary picks out the key messages.

The Department of Health and the Department for Education and Skills published the National Service Framework (NSF) for Children, Young People and Maternity Services in 2004. Standard 11 focuses on maternity services, and promotes normality and choice, longer postnatal support, services for pregnant women from disadvantaged or minority groups and communities and better birth environments. NCT’s document summary is available in the related documents section.

Scotland

A refreshed framework for maternity services 2011outlines the principles which govern maternity services from pre-conception, through pregnancy, childbirth and postnatal care and into parenthood in Scotland.

Pathways for maternity care 2009 is part of the Keeping Childbirth Natural and Dynamic (KCND) programme, which has been developed to support the multi-professional team to implement the principles outlined in the Framework for Maternity Services in Scotland, which states that pregnancy should be midwife-managed and woman-centred. An NCT document summary picks out the key points.

Implementing a Framework for Maternity Services in Scotland. Overview Report of the Expert Group on Acute Maternity Services. The Overview Report of the Expert Group on Acute Maternity Services (EGAM) was published in 2003 and stated that maternity care professionals must work to promote the notion of pregnancy and childbirth as being normal life events, but must also have the skills to recognise when either the mother or baby is having problems.

The Minister for Health and Community Care in Scotland set up the Expert Group on Acute Maternity Services (EGAMS), a short-life working group of professionals and other stakeholders in maternity services in February 2002. This Group was asked to consider how the principles in the Framework should be applied to care during childbirth, and the services in the acute health care sector which deliver that care. In January 2003 they published the Expert Group on Acute Maternity Services Reference Report.

The Routine examination of the newborn best practice statement (BPS) was originally published in 2004. A working group took the decision to review it in 2007, and the updated version has recently been published.

The maternal history taking best practice statement (BPS) was originally published in 2004. As NHS Quality Improvement Scotland (NHS QIS) has a commitment to review and, if necessary, update BPSs every three years a working group was formed to establish whether a revised BPS was required. The group agreed that there was a need to update the BPS, it was put out to consultation and the revised BPS was published in 2008. (Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement Scotland on 1st April 2011.)

Wales

In September 2011 the Welsh Government published A Strategic Vision for Maternity Services in Wales. Tackling inequities in terms of access to and the outcomes from maternity services in Wales is the cornerstone of this document, given the high level of social inequality in Wales. The Welsh Government wants to promote pregnancy and childbirth as an event of social and emotional significance where women and their families are treated with dignity and respect.

National Assembly for Wales Health produced a report in July 2010 on the lack of staffing and funds in neontatal units. The Report on inquiry into neonatal care in Wales states that that neonatal units should aim to work at 70% occupancy in order to maintain a manageable workload and to cope with sudden peaks in demand but evidence shows that levels are often way above this, with some units having an occupancy rate of 130% to 140%.

The National Service Framework (NSF) for Children, Young People and Maternity Services was published in September 2005. In particular, Chapters 2 & 3 of the Welsh NSF, which focus on ‘Key Actions Universal To All Children’ and ‘Maternity Services’ are relevant to the work of the NCT. The Welsh NSF promotes normality and choice, breastfeeding, services for pregnant women from disadvantaged or minority groups and communities and better birth environments. NCT’s document summary looks at the recommendations.

The All Wales Clinical Pathway for Normal Labour published in 2004 and provides support for midwives who wish to practice evidence-based clinical care of the highest standard with minimal unnecessary intervention. It also provides a framework to maximise the opportunity for women in Wales to experience normal childbirth.

Maternity Services: Report Presented by the Auditor General to the National Assembly on 19 June 2009
Maternity care in Wales generally meets an appropriate standard but this report highlights some specific problems, including the way in which labour is managed and dissatisfaction with support for infant feeding.

Northern Ireland

A strategy for maternity care in Northern Ireland 2012 - 2018 was published in July 2012 with the aim of ensuring that maternity services meet the needs of the socially disadvantaged as well as the advantaged. The strategy proposes a network of maternity services in which the majority of women are cared for nearer to home and in which the skills of GPs, midwives and obstetricians are used appropriately and unnecessary interventions are avoided.

Published in 2010 A Northern Ireland strategy for nursing and midwifery 2010 – 2015 is the culmination of a range of work which has taken place in Northern Ireland in response to the Modernising Nursing Careers agenda since its launch in 2006 and is in keeping with the work currently being undertaken in the Midwifery 2020 initiative.

Published in April 2010 by the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) Development of a maternity support worker programme for Northern Ireland: final report documents the developments made in supporting the Northern Ireland agenda with regards to skill mix in maternity services and the development of a regional maternity support worker programme.