Push to improve London’s maternity services post-pandemic

The Mayor is being urged to help drive up maternity care standards in London after the London Assembly Health Committee discovered a “postcode lottery” in the delivery of maternal health services post-pandemic.

It is calling on the Mayor to advocate for the NHS in London to carry out a review to learn lessons from the COVID-19 crisis, with the aim of determining how maternal health services in London should respond to future pandemics.

Following the negative impact of the pandemic on mental health, it is also urging the Mayor to work with Mental Health First Aid England to explore creating a bespoke curriculum for the mental health of pregnant women and birthing people, new mothers, and parents.

An investigation by the Committee looked at the impact of the pandemic on maternal health and services in London, the impact of staffing shortages, and the inequalities that exist across maternal health outcomes.

Evidence from organisations including Pregnant Then Screwed, Birthrights, Five X More and the Royal College of Midwives revealed that challenges remain for the delivery of services in London – particularly around staffing levels and retention of staff.

The Committee has today published its findings, highlighting:

• During the pandemic, there were disparities in the levels of care provided between different NHS Trusts, as they took different approaches to enforcing Covid-19 restrictions.
• Inadequate staffing levels are a significant challenge facing London’s maternity services, with retention of staff in particular a major obstacle.
• The pandemic had a negative impact on the mental health of pregnant women and their partners. Mental health is a key factor in maternal health outcomes, as the most common reason for death for women in the 28-day postnatal period after giving birth is suicide.
• The midwifery and maternity support workforce is much more ethnically diverse in London than in the rest of the UK, but staff from minority ethnic groups are more likely to face discrimination, be disciplined, and less likely to be promoted.

The Committee conducted a survey of Londoners who have recently used maternity services in London, especially during the pandemic. It received 140 responses from those that had used maternity services in London and found similar themes to evidence by the organisations.

One respondent said: “I think there is massive disparity across the capital. I received amazing care and saw the same midwife during my pregnancy and birth, but this isn't the same in many other boroughs.”

Another responded: “Appropriate levels of staff would allow mothers to get adequate support before, during and after labour. The midwives seem exhausted and rushed off their feet. There is [only] so much that they can do when they are pushed to their limits.” 

Maternity care in the UK has been in the spotlight after several high-profile inquiries, including the Ockenden Review and investigations into maternity services in Morecambe Bay, East Kent and Shrewsbury and Telford.

The Committee outlines nine recommendations in its report, including:

• The Mayor should use his convening and advocacy powers to encourage higher standards of care and help prevent a postcode lottery in the delivery of maternity services in London.
• The Mayor should advocate for the NHS in London to carry out a review to learn lessons from the pandemic, with the aim of determining how maternal health services in London should respond to future pandemics.
• The Mayor should work with Mental Health First Aid England to explore creating a bespoke curriculum for the mental health of pregnant women and birthing people, new mothers, and parents.
• The Mayor should lobby the NHS to improve its support for maternity staff from ethnic minority groups and strengthen anti-racist initiatives that impact maternity staff.

Chair of the London Assembly Health Committee, Krupesh Hirani AM, said: 

“I became a parent in the pandemic and saw first-hand that it had a significant impact on how maternity services were delivered in London. 

“Services were put back to a minimum level, some appointments were conducted remotely, wider support services were reduced, and, perhaps most notably, restrictions were put on birth partners attending scans and appointments.

“We recognise that this was a challenging time for the NHS and restrictions were put in place to keep people safe, but our investigation shows that lessons need to be learnt from the pandemic about how to improve maternity care in London. 

“Through our survey we heard about supportive and caring midwifery teams at London hospitals, but we were also told about difficult experiences while restrictions were in place – in some cases with long-lasting consequences on mental and physical health. 

“The Mayor has a role to play in pushing for change in maternal health outcomes across our city and we urge him to take on our recommendations and advocate on behalf of those using these services in our city.”

Notes for editors:

1. The embargoed report is attached.
2. Krupesh Hirani AM, Chair of the Health Committee, is available for interview. 
3. Find out more about the work of the Health Committee.
4. As well as investigating issues that matter to Londoners, the London Assembly acts as a check and a balance on the Mayor.
5. Survey methodology note: From July to October 2022, the Committee invited those who have been pregnant, their partners and close friends/family members to complete a survey asking questions about their experiences of maternity services in London. The survey received 140 responses; as data is not weighted to be representative of the population, results should be interpreted with some caution. The survey asked about perceptions on the quality of care at each stage of pregnancy. Given the personal nature of the subject area, respondents were asked before each set of questions whether they wanted to see questions relating to each stage and all questions were optional, with open text boxes so that as much or little information could be shared as respondents felt comfortable.