Measurement: Patterns of maternity care in English NHS trusts

This is the second report published by RCOG (2016) describing patterns of maternity care practice and outcomes using data routinely collected by English NHS Hospitals.


Even though normal births were part of the suite of indicators for analysis, these results were excluded from the analysis due to data quality issues. Also excluded from this report were indicators on caesarean section under general anaesthetic, epidural rates in both vaginal and instrumental deliveries and severe postpartum haemorrhage.

As the necessary statistics were not available in the routine datasets to measure the proportion of normal births, the number of “spontaneous births without induction, instrument use or caesarean section; adjusted for maternal characteristics and clinical risk factors” was used (p. 9, RCOG, 2016). This was presented as a proxy and was specifically unable to exclude epidurals from the analysis. This indicator titled ‘unassisted vaginal deliveries’ looked at the proportion with the following data points:

Numerator: Number of spontaneous vaginal births without induction, instrument use or caesarean section

Denominator: All deliveries, excluding records missing information on delivery onset

Risk adjustment was made for age group, deprivation, ethnicity, placenta praevia and abruption, birthweight, pre-existing or gestational diabetes in pregnancy, pre-eclampsia and the data was presented separately based on parity.

The data is also presented online by trust and national level.

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