Summary of what we heard
The NSW Health policy, Towards Normal Birth in NSW is under review. As part of the consultation process, consumers were asked to share their views about what is important to them in maternity care through an online survey conducted late in 2018. NSW Health is grateful to the 17,725 individuals and 41 organisations who responded to the survey.
Who answered the survey?
Most people who responded to the survey were women (almost 99%), spoke English at home (97%) were non-Indigenous (97%), aged 30 to 39, lived in a major city, had a previous pregnancy, received pregnancy care through a public hospital and gave birth in a public hospital.
How did people view their maternity care?
The survey asked for respondent’s views about the importance of certain aspects of maternity care. People who completed the survey were asked to rate these aspects of maternity care as either not important, slightly important, important or very important. For the purpose of the survey, maternity care included care during pregnancy, care during labour and birth and care immediately after birth.
Respondents rated having the same healthcare professional throughout their maternity care as very important (60%) or important (30%). Respondents were more likely to rate having the same healthcare professional as very important if they spoke a language other than English at home, lived in very remote areas, received pregnancy care from a private obstetrician, a private midwife or an Aboriginal Maternal and Infant Health Service (AMIHS) or gave birth in a private hospital or at home.
Survey respondents rated the availability of midwifery-led care as very important (50%) or important (30%). Over 50% of the survey respondents rated partner involvement in decision-making as very important and 30% rated it as important.
A smaller proportion of respondents (45%) rated access to interpreter services as very important or important. Respondents were more likely to rate access to interpreter services as very important if they spoke a language other than English at home or were of Aboriginal and/or Torres Strait Islander origin.
Survey respondents rated a choice in place of birth as very important (60%) or important (30%). A smaller proportion rated access to home birth as very important (15%) or important (16%).
Provision of care in labour and birth by a health professional known to the woman was very important (50%) or important (30%) to respondents. Overall, 40% of respondents rated an agreed birth plan that describes preferences and expectations as very important and around 30% rated an agreed birth plan as important. Respondents rated referral to another hospital if birth choices cannot be met as very important (40%) or important (40%).
There was a very strong preference for follow-up care to support recovery and parenting with overall almost 80% of respondents rating it as very important and 20% rating it as important.
There was a very strong preference for breastfeeding support with 80% of respondents rating it as very important and 16% rating it as important. The vast majority of survey respondents rated support and follow-up care highly after the loss of a baby, with overall 95% of respondents rated it as very important.
Do people receive enough information during pregnancy?
During their maternity care, people need to receive sufficient, personalised information to enable decision making. The survey asked about information respondents received in their current or most recent pregnancy to prepare them for labour and parenthood. The survey asked respondents their preference for receiving information, with 80% noting they prefer to receive information face-to-face rather than in print form, a phone app or sourced from a website.
Respondents were most satisfied with the amount of information they were given on smoking, alcohol and other drugs, tests and screening, and baby’s movements. Topics where respondents were most likely to feel they received no or limited information included family relationships, managing existing health conditions, pelvic floor exercises, the risks and benefits of different ways of giving birth, what will happen after the birth, and emotional wellbeing in early parenthood.
What do people value about maternity care?
The survey asked respondents to rate out of 5 a series of statements about maternity care in terms of what they value (0 = low value, 5 = high value). The statements were drawn from evidence about the aspects of care shown to have the greatest influence on improving outcomes for mothers and babies. The statements were:
- People who are planning a pregnancy receive clear and consistent information about preparing for a healthy pregnancy.
- Pregnant women are able to access care early and regularly.
- During pregnancy, women and families receive clear and consistent information and support to be healthy and to prepare to look after their baby.
- Women and families receive maternity care that is respectful of their social and cultural background.
- Women and families who have additional needs are referred to the services they need.
- Women are offered appropriate choices in how their maternity care is provided.
- Care plans reflect the individual needs of women, babies and families.
- Different care options ae clearly explained and women and their partners are actively engaged in decision making about their care.
- Women receive care during labour and birth that is appropriate to their individual needs and expectations.
- Women’s views are used to improve their care and services.
All statements were rated over 3.78 out of 5 by survey respondents. The two aspects of care that were valued most highly overall were:
Women receive care during labour and birth that is appropriate to their individual needs and expectations. (average score out of 5 = 4.06)
Women and families who have additional needs are referred to the services they need. (average score out of 5 = 4.05)
Respondents were more likely to value an aspect of care very highly if they were planning a pregnancy or gave birth at home. They were less likely to value an aspect of care very highly if they were of Aboriginal and/or Torres Strait Islander origin, spoke a language other than English at home or lived in very remote areas.