Between 2017 and 2019, the proportion of sites with an obstetric unit (OU) that was co-located with an alongside midwifery unit (AMU) increased from 67% to 71% overall (from 124 to 132 out of 186 sites with an OU). However, the number of freestanding midwifery units (FMUs) decreased by four (from 95 to 91), and long-term FMU closures increased, with a further eight FMUs closed for births from several months to more than a year.

Review reasons for any short-term, long-term and permanent closures of FMUs. Evaluate how effectively the viability of these units is assessed in terms of demand and resources, both in local and regional context. Evaluate the impact of these closures on the women affected.

(Maternity service providers and commissioners, Local Maternity Systems and equivalent regional collaborations, relevant national and regional transformation and improvement initiatives, women and families using the services and their representatives)

Perinatal mental health service provision was expanded, with more participation in networks (91% of 151 trusts and boards overall), increased access to community perinatal mental health teams and specialist midwives (91% and 87% of trusts and boards respectively), and more psychiatrist clinics (58% of 186 sites with an OU).

Ensure participation in a perinatal mental health network where this is not already the case, in order to optimise access to and effectiveness of the increased local provision of perinatal mental health support services.

(Maternity service providers and commissioners, Local Maternity Systems and equivalent regional collaborations, relevant national and regional transformation and improvement initiatives,* women and families using the services and their representatives)

Access to electronic maternity records has improved for community midwives, with 66% of trusts and boards (out of the 140 that reported full access for maternity clinicians in hospital) reporting access at any location and 90% at the community base. However, still only 19% reported that women could access their own record, and the proportion where GPs had access decreased from 29% to 21% of trusts and boards.

Continue to improve access to electronic maternity records, both for women and for all healthcare professionals involved in their maternity care.

(Maternity service commissioners and providers with national government support and in collaboration with maternity and GP system suppliers, relevant national and regional transformation and improvement initiatives,* women and families using the services and their representatives)

The proportion of trusts and boards engaging with women through Maternity Voices Partnerships or Maternity Services Liaison Committees increased from 83% to 90%, while the proportion gathering feedback via surveys or focus groups increased similarly. However, the proportion of services involving women in audit, guideline development or labour ward forums decreased from 50% to 44%.

Encourage women’s involvement in audit, guideline development and labour ward forums (where these exist).

(Maternity service providers and commissioners, Local Maternity Systems and equivalent regional collaborations, women and families using the services and their representatives, national service user organisations supporting local collaborations with service users)

85% of services are in the process of implementing continuity of carer models, either through caseloading, teams set up to provide continuity, or both. However, nearly all currently serve only particular, sometimes small, groups of women with these models and scaling this up may be a challenge.

Provide adequate resource to record all care contacts electronically in order to ensure effective monitoring of the level of continuity of carer that women experience (software, hardware and connectivity, and staff time).

(Maternity service commissioners and providers with national government support and in collaboration with system suppliers, Local Maternity Systems and equivalent regional collaborations, relevant national and regional transformation and improvement initiatives,* women and families using the services and their representatives)

The reported level of provision of most services that were widely available in 2017 was maintained or increased slightly, and there was a notable increase in multiprofessional cardiac clinics and female genital mutilation services (now available at 25% and 55% of sites with an OU, respectively). However, despite their continued importance, provision of smoking cessation and weight management support remained similar to 2017 at 72% and 45% of trusts and boards, respectively, possibly reflecting cuts to public health budgets or competing demands on resources.

Improve access to smoking cessation and weight management support services before, during and after pregnancy.

(Public health service providers/local authorities, maternity service providers and commissioners, national neonatal improvement initiatives, national governments)

Although fewer sites reported entirely unfilled obstetric middle grade rota gaps in the 3 months leading up to the survey in 2019, the proportion requiring locum cover to staff the rota remained the same at 83%. Equally, at 51%, the proportion of sites reporting that all women received one-to-one midwifery care during established labour has not increased since the 2017 survey.

Evaluate medical and midwifery staffing requirements, taking into account the range of national ambitions, and fund services accordingly.

(National governments, professional bodies, relevant national and regional transformation and improvement initiatives,* maternity service providers and commissioners, women and families using the services and their representatives)

(Maternity and neonatal service providers and commissioners, relevant national and regional transformation and improvement initiatives)*

Provision of private bathrooms for all birth rooms and of bedrooms for parents of babies admitted to neonatal units (at a ratio of one bedroom per intensive care cot) increased only slightly (to 68% and 54% of sites, respectively). The proportion of sites with some ward rooms with more than four beds remained similar at 32%.

Review the quality of the care environment for women and their families. Focus efforts on improving privacy and on measures that help families stay together while the mother and/or baby are admitted, including private bathrooms for all birth rooms and bedrooms for parents of babies admitted to neonatal units.

(Maternity and neonatal service providers and commissioners, women and families using the services and their representatives, relevant national and regional transformation and improvement initiatives)*