Maternity Services An epidemiological needs assessment

1
Maternity Services An epidemiological needs
assessment

• Oxfordshire PCT

2
Introduction

• Maternal health refers to the health of women
  during pregnancy, childbirth and the postpartum
  period
• Major improvements in outcomes, but variations
  exist in the UK.
• The aim of a maternity service should be the
  delivery of high quality health care to pregnant
  women and their babies
• This level of care has to be delivered in an
  environment of patient choice

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Drivers

• Our Health, Our Care, Our Say direct access
  to a midwife
• NSF (the maternity standard) choice, high
  quality, perinatal psychiatry etc..
• Maternity Matters four national choice
  guarantees

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Aim of this HNA

• The key aim of this needs assessment is to inform
  future commissioning priorities through
  identifying those mothers/infants who currently
  experience the poorest outcomes and identify
  recommendations to enable the service to provide
  them with an equal chance of good maternal/infant
  health

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Related targets

• Reduce health inequalities by 10 by 2010 as
  measured by infant mortality and life expectancy
  at birth.
• Deliver a 1 point reduction per year in the
  proportion of women who smoke throughout
  pregnancy, especially from disadvantaged groups
• Deliver an increase of 2 per year in breast
  feeding initiation rate especially among mothers
  from disadvantaged groups.

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Current service

• Two consultant-led units
• John Radcliffe Womens Centre and the Horton
  Maternity Unit
• Three community midwifery-led units
• Chipping Norton Community Hospital, Wantage
  Community Hospital, Wallingford Community
  Hospital
• A Community Midwifery Service operates via
  Community teams based at Abingdon, Bicester,
  Chipping Norton, Didcot, Oxford City,
  Wallingford, Wantage, Witney, Carterton and at
  Thame.

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Population

• GP registered vs Census estimates
• 15-44year old women
• 146000 vs 132000
• Nearly 40 of all women in this group
• Oxford city has a higher proportion
• 2 projected increase in Oxfordshire over the
  next 20 years City and Cherwell mainly
• Note wards with highest population and
  projected increases

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Deprivation

• The Index of Multiple Deprivation 2007
• 8330 women in the 15-44yr age group resident in
  these five wards
• Note - IDACI scores for SOAs

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Fertility
Home delivery rate 3 in 2006
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Fertility and deprivation
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Other features

• Teenage pregnancy rates The Oxfordshire target
  is to hit 17.3 by 2010. 2006 under 18 conception
  rate was 27 per 1000 women aged 15-17yrs
• Lone parent households with dependant children -
  Based on the 2001 census, there were 394 lone
  parent households with dependent children in
  Oxfordshire, 264 of whom were under 29years of
  age.

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Activity

• ORH vs SUS
• Workload 9362 women booked for ANC with the ORH
  in 2007
• Note wards with the highest number of births

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Activity contd..

• Bookings after 20 weeks 6.5 late bookers (no
  relationship with deprivation, ? Relationship
  with black and Chinese ethnic groups, South Oxon
  wards?)
• 35 either obese or overweight

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Activity contd..

• 70 dating scan performed, near universal
  congenital anomalies scanning
• Downs syndrome screening triple test vs
  combined test, time of screening
• Haemoglobinopathies 84 uptake
• Infectious diseases opt out working well
• Mental health screening basic personal
  screening questions

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Activity contd..

• Live and still births (SUS) 7519 in 2006
• 611 women who were residents of the five most
  deprived wards in Oxfordshire delivered at the
  ORH during 2007.
• The Horton delivered a higher proportion of women
  from the most deprived quintile of wards

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Activity contd..

• Using 2006 SUS data for women resident in
  Oxfordshire PCT, we noted an overall C-section
  rate of 18.9 per 100 live births ( no
  relationship with deprivation, ?relationship with
  age extremes and black ethnic group)
• Lowest CSR in South Central as opposed to RBBH
• Using SUS data for 2006, we noted an assisted
  delivery rate of 16.1 per 100 live births for
  women resident within Oxfordshire PCT.
• The Healthcare commission data indicates that the
  ORH Trust has the highest rates of vaginal
  delivery although the rates of epidural pain
  relief are the highest in the South Central
  region as well. Hence overall normal delivery
  rates are just under 40

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Activity contd..

• The ORH has the second highest rate of vaginal
  3rd and 4th degree tears as noted in the HCC
  survey.
• The rate of eclampsia is less than 1 per 1000
  deliveries at the ORH.
• There were 10377 Obstetric FCEs during 2006 for
  women resident in Oxfordshire PCT. 9961 (96) of
  these occurred at the ORH with the RBBH
  accounting for 2.5 of the total.

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Activity contd..
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Activity contd..

• In 2006, 8.3 of live births among Oxfordshire
  women resident in the 30 most deprived wards were
  under 2.5kgs as compared to 6.4 of women
  resident in the 30 least deprived wards.
• Between 2004 and 2007, 21,387 women delivered at
  the ORH. Of these women, 10.8 were smoking at
  the time of delivery.

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Activity contd..

• The overall breast feeding initiation rates have
  increased over the years from 73.97 to 77.23 per
  100 live births.

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Patient survey
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Staffing and Finance

• Staffing - Towards Safer Childbirth indicates
  that to support on-to-one care in delivery the
  equivalent of 36 midwives per 1000 deliveries are
  required rising to 40 in trusts handling more
  complex women.
• The HCC survey indicates that the ORH Trust which
  receives tertiary referrals is operating at a
  shortfall.

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Findings

•         There are roughly 146,693 women in the
  child bearing age group (15-44yrs) registered
  with Oxfordshire PCT in 2008. This figure however
  hides a variation
•         Over the next 20 years, the population
  of 15-44yrs women is likely to grow by 2. This
  growth is expected to be led by Cherwell Vale and
  Oxford City.
•         There is a higher proportion of women
  living in the more deprived quintiles of wards in
  Oxfordshire as compared to the least deprived
  quintiles.
•         Live birth rates and Fertility rates
  have been relatively stable over the last three
  years. More deprived wards have higher rates of
  fertility.
•         Between 88 to 97 of Oxfordshire women,
  receive the minimum number of antenatal checkups
  at the ORH.

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Findings contd..

• Just under 7 of pregnant women booked late.
  Women from the less deprived quintile of wards
  tended to book later than women from more
  deprived wards. There was a higher proportion of
  late bookings among women from Black and Chinese
  ethnic groups.
•         There was a higher proportion of
  pregnant women in more deprived wards who were
  either obese or overweight at the time of
  booking. The prevalence of overweight among
  pregnant women mirrors community prevalence
  rates.
•         Most deliveries at the ORH take place at
  the John Radcliffe. However, a higher proportion
  of women from more deprived wards were delivered
  at the Horton hospital in 2007. Home delivery
  rates are around 3.

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Findings contd..

• The C-section rates at the ORH are the lowest in
  the South Central SHA region. There was no
  variation by ethnicity or deprivation status.
  However, morbidity due to perineal tears was
  higher probably a direct result of the higher
  number of normal deliveries conducted at the
  ORH.
•         Cherwell DC had the highest rates of
  infant mortality and low birth weight, although
  not statistically different from other DCs or
  England rate.
•         Smoking rates at booking are highest as
  expected among women from most deprived wards.
  However, the rates of quitting by the time of
  delivery was also higher among the most deprived.
  This addresses inequalities.
•         The gap between the most deprived wards
  and the least deprived in terms of breast feeding
  initiation rates has been reduced in the last
  year.

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Thanks

• DSU (Anne Marie)
• Nikki Di Mauro
• Midwifery team at the ORH