Some NHS trusts in England need to do more to make maternity services safer and improve choices for mothers, says the Healthcare Commission.
Some NHS trusts in England need to do more to make maternity services safer and improve choices for mothers, the Healthcare Commission has said.
A survey of 150 trusts by the watchdog found low staffing levels and poor facilities in some hospitals.
A survey of 150 trusts by the watchdog found low staffing levels and poor facilities in some hospitals.
Midwives said ministers would struggle to meet a promise to allow every mother to choose where she gave birth by 2009. The government said it was providing £330m to help recruit 4,000 midwives by 2012 and was "listening" to mothers.
Midwives said ministers would struggle to meet a promise to allow every mother to choose where she gave birth by 2009.
I don't ever want again to be reading another report into high death rates at a maternity unit Sir Ian KennedyHealthcare Commission
The government said it was providing £330m to help recruit 4,000 midwives by 2012 and was "listening" to mothers.
The report was commissioned after a series of separate Healthcare Commission investigations into deaths at maternity hospitals revealed similar problems.
The report was commissioned after a series of separate Healthcare Commission investigations into deaths at maternity hospitals revealed similar problems.
In total, 150 NHS trusts in England were involved, and services from the start of pregnancy through to postnatal care were probed.
The survey looked at services from the start of pregnancy through to postnatal care.
I don't ever want again to be reading another report into high death rates at a maternity unit Sir Ian KennedyHealthcare Commission
The report revealed some trusts had as few as two beds available per 1,000 births, meaning that each bed was used, on average, by more than one woman in 24 hours.
The report revealed some trusts had as few as two beds available per 1,000 births, meaning that each bed was used, on average, by more than one woman in 24 hours.
Only 16% of units had one bathroom per delivery room, and fewer than half of the women surveyed reported that the toilets were "very clean".
Only 16% of units had one bathroom per delivery room, and fewer than half of the women surveyed reported that the toilets were "very clean".
Restricted choice
The report found that some hospitals were far worse staffed than others, with a ratio of fewer than 23 midwives per 1,000 births, compared with 40 per 1,000 in the most generously staffed units.
The report found that some hospitals were far worse staffed than others, with a ratio of fewer than 23 midwives per 1,000 births, compared with 40 per 1,000 in the most generously staffed units.
In the patient survey, 89% of women said they had been happy with their experience during pregnancy and birth.
In the patient survey, 89% of women said they had been happy with their experience during pregnancy and birth.
'Systematic problems'
However, while the majority of women were being offered some degree of choice, such as a midwife-led unit, or a home birth, it said two-thirds of trusts could currently offer only a consultant-led service in its hospitals.
However, while the majority of women were being offered some degree of choice, such as a midwife-led unit, or a home birth, it said two-thirds of trusts could currently offer only a consultant-led service in its hospitals.
Labour pledged in its 1995 manifesto that by 2009 all women would have a choice of birth location, and restated this in its "Maternity Matters" document published last year.
Labour pledged in its 1995 manifesto that by 2009 all women would have a choice of birth location, and restated this in its Maternity Matters document published last year.
Call to action
The Healthcare Commission's Sue Eardley on the report
Sir Ian Kennedy, the Healthcare Commission chairman, said that many hospitals had made improvements already as a result of the review, but problems remained.
Healthcare Commission chairman Sir Ian Kennedy said many hospitals had made improvements already as a result of the review but problems remained.
"There is no doubt that the report contains some tough messages," he said.
"There is no doubt that the report contains some tough messages," he said.
"There is clearly more to be done to improve the quality of clinical care as well as the experiences of women."
"There is clearly more to be done to improve the quality of clinical care as well as the experiences of women."
He added: "I don't ever want again to be reading another report into high death rates at a maternity unit - I don't want our investigators to be again describing to a young family what happened to their mum."
He added: "I don't ever want again to be reading another report into high death rates at a maternity unit - I don't want our investigators to be again describing to a young family what happened to their mum."
The Department of Health's chief nursing officer Christine Beasley said: "Women tell us they want more choice in their maternity care, including how and where they give birth, and we are listening.
The commission's chief executive Anna Walker told BBC News that if it was thought a unit was not safe it would be closed down.
"That is why, in January, we announced an additional £330 million funding and action to recruit an additional 4,000 midwives by 2012.
She said: "There are many maternity units in this country which do excellent work but what our report has found is that there are some systematic problems in some units.
"Some trusts are doing well and we will work with those trusts who need more support."
"Those centre on low staffing levels, sometimes inadequate training and supervision of those staff, checks before birth and after birth not always systematically carried out, and in some places shortages of beds."
However, Dame Karlene Davis, general secretary of the Royal College of Midwives, said that maternity services still did not appear to be a priority, and there was no evidence to suggest that the midwife target would be met.
Midwife target
She added: "There is also no evidence that the promises in the Maternity Matters document for more choice for women are anywhere near being met."
The government's national clinical director for children, young people and maternity services, Sheila Shribman, welcomed the report.
She said: "The UK is one of the safest places in the world to have a baby and the report does acknowledge that women have a positive experience.
"But there is more to do ensure people do have the choice and the experience that they want."
The Department of Health's chief nursing officer Christine Beasley said: "Women tell us they want more choice in their maternity care, including how and where they give birth, and we are listening."
However, Dame Karlene Davis, general secretary of the Royal College of Midwives, said maternity services still did not appear to be a priority, and there was no evidence to suggest that the midwife target or choice for mothers would be met.
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