National Maternity and Perinatal Audit on Maternity Care

Today sees the launch of the National Maternity and Perinatal Audit on NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or above. A small group of BigBirthas members (and others) were on the lay committee that oversaw the report’s creation. I’m really proud of our impact on (some of) the language used and the presentation of the data.

Image of the front cover of the National Maternity and Perinatal Audit on NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or above, showing a woman with her hair tied back holding a newborn so it can look down into her face.

The data covered births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. It came from computerised records held by the NHS, so there was a LOT of data available. This brought its own issues, however! Not all Trusts and Health Boards record the same information in the same way.

Limitations In The Data

There were problems with missing and incomplete information. Some data had to be discarded because it was clearly inaccurate. For example, there were significant number of caesarean sections that supposedly took place in Midwife Led Units!? We were weren’t able to get all the answers, because a lot of information we wanted to see simply isn’t recorded.

We would have liked to know how many people were refused access to MLUs or pools due to BMI. How many people intended to birth at home or in a MLU but ended up transferring in, and whether this differs for people of higher BMIs? How estimated birth weight from scans differs from actual birth weight, and whether bigger people are more likely to be given inaccurate estimates? And more. We had LOTS of questions.

The numbers sadly don’t give any picture of how people felt about their birth experiences. They also don’t tell us whether decisions to intervene were necessary, only that they happened. Sometimes the numbers in question were too small to be disclosed because of the potential risk of identifying individuals.

However, we were able to provide valuable insight to the researchers in a number of ways. They were very respectful of our views and experiences. Sometimes the things we said shocked them and/or gave a perspective they hadn’t considered.

Our Input Into The National Maternity And Perinatal Audit

I am pleased to say I can hear the voice of the Lay Committee throughout the report.

We were very clear that we didn’t want the language to focus on ‘obese women’. Rather than using the words ‘obese’ and ‘obesity’, which find very loaded, the report refers to ‘BMI of X’ throughout. That’s not to say we don’t find BMI problematic, but at least here we’re using a population level measure on population level data!

We actually wanted more inclusive language than just ‘women’ throughout. Sadly, due to policies at the RCOG, this wasn’t possible in the National Maternity and Perinatal Audit.

We were also very wary of how things might be taken out of context, particularly by the media. We’ll have to see how that goes! So we were very insistent that wherever risks were quoted, they are not just given as relative (3x risk) but as ‘absolute’ (eg 1 in a 1000). This wasn’t followed completely, but almost.

Where possible, we asked the researchers to rephrase paragraphs to be more neutral we thought would be quoted in isolation and used as scaremonger fodder.

What I’m most proud of is our suggestion that the statistics should be separated out further than just BMI classes. We were keen to see that the data was not treated as though people with the same BMI are a complete, homogenous group, but realising that there are distinct experiences and sub-categories within that group. This yielded some very interesting results, and I really hope future researchers follow this more nuanced approach to looking at BMI pregnancy statistics.

You can access the report here:

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