In the UK, figures are collected by three main mechanisms:
• Statutory reporting schemes (e.g. registration of births to the Office of National Statistics (ONS) by the parents; birth notification to the Director of Public Health by midwives or medical staff; reporting of congenital abnormalities to ONS)
• Non-statutory but obligatory schemes (e.g. those organised for accreditation and training by the Royal Colleges; the Confidential Enquiries into Maternal Deaths)
• Specific projects, which may or may not be supported by national or professional bodies (e.g. surveys carried out by the Audit Commission or National Birthday Trust; hospital- or department-based projects; Obstetric Anaesthetists’ Association (OAA) or Association of Anaesthetists projects)
Anaesthetists may be involved in some of the above schemes, and the information gained maybe of interest to obstetric anaesthetists in particular. There maybe considerable overlap between the information gained for public health or political purposes and that gained for research or audit purposes. The bodies that collect the information and support the schemes may also have conflicting interests.
Some of the national figures from recent years are provided in Table 177.1. See also Chapter 89, Maternal mortality, and Chapter 161, Perinatal mortality.
Problems and special considerations
As with all large information-gathering schemes, there may be inaccuracies in the figures collected, which in turn can be interpreted in different ways. It is also generally easier to collect information about outcome events than about denominators - for example, the total number of births is known but the total number of pregnancies is not (it is estimated from the number of births, the number of ectopic pregnancies and the number of legal and spontaneous abortions from hospital data systems and morbidity reports). There may also be discrepancies between data collected for the UK as a whole and its composite parts. There are also considerable differences between the ability to collect information, and thus contribute to the various reporting schemes, of the approximately 320 National Health Service and independent units in the UK in which babies are born. Finally, centrally collected and administered schemes may report several years after the period of interest.
Table 177.1 UK maternity statistics (per year) for 2017, unless otherwise stated
|
Total number of live births and stillbirths |
~680,000 (680,000-790,000 over past 20 years) |
|
General fertility rate |
~60-62 live births per 1000 women aged 15-44 (~90 in 1950s-1960 s) |
|
Total number of pregnancies |
860,000-875,000 |
|
Legal abortions |
~190,000 |
|
Mothers < 20 years old |
3.0% |
|
Mothers > 35 years old |
21.3% |
|
Gestation < 37 weeks or > 41 weeks |
5-7% each |
|
Caesarean section rate (England) |
24-28% since 2006 (emergency rate 12-15% and elective rate 16%) |
|
General anaesthesia for caesarean section |
8-10% (> 50% in 1989-90) |
|
Forceps or ventouse delivery (England) |
12.4% |
|
Induction rates (England) |
29% |
|
Epidural rate in labour |
Uncertain; thought to be ~20-30% |
Figures from Office for NationalStatistics and NHS Maternity Statistics.
Key points
• Collection of maternity and related data may be a statutory requirement, an obligatory professional requirement or a non-obligatory but desirable practice.
• A number of national data collection schemes produce reports of interest to anaesthetists.
Further reading
Office for National Statistics. Births, deaths and marriages. www.ons.gov.uk/peoplepopulationand community/birthsdeathsandmarriages (accessed December 2018).
NHS Digital. NHS maternity statistics, England 2017-18. https://files.digital.nhs.uk/ pdf/l/1/hosp-epis-stat-mat-repo-2016-17.pdf (accessed December 2018).