Pregnancy and Maternal Health

This topic area covers statistics and information relating to pregnancy and maternal health in Hull including local strategic need and service provision. Further information is also available within Births and Infant Health, Breastfeeding, and Smoking in Pregnancy within Pregnancy and Infants within Children and Young People. Further information relating to antenatal and newborn screening can be found under Screening and Vaccinations within Children and Young People. Information on Under 18 Conceptions is given under Lifestyle Factors within Children and Young People, and information on Sexual and Reproductive Health is given under Health Factors within Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• During 2018/19, women in Hull compared to England are less likely to take folic acid prior to pregnancy (14% versus 27%) and are more likely to be obese (31% versus 22%) or to be smokers (23% versus 13%) in early pregnancy (as recorded within their first antenatal appointment), although a relatively high percentage of women in Hull access maternity care early (within 10 completed weeks of their pregnancy) compared to England (64% versus 58%).
• Women were also more likely to continue to smoke during their pregnancy. The percentage of women in Hull who were recorded as a smoker at the time of the delivery was almost twice as high in Hull as the percentage in England for 2022/23 (18.5% versus 8.8%). During 2022/23, 525 women were recorded as current smokers at the time of delivery.
• Local data for 2016/17 showed that over half of women at their first antenatal appointment were overweight including 27% who were obese.
• The age of mothers is younger in Hull than across England and the region, although this has changed over time with fewer younger mothers in Hull compared to 20-25 years ago. The percentage of births to mothers age 35+ years has also increased in Hull.
• The percentage of caesarean section births has increased over time in both Hull and England from around one in four births in 2014/15 to more than one in three births in 2022/23. The increase in the percentage of caesarean section births has increased in Hull at a very similar rate to that observed in the region and for England. The rate increased between 2013/14 and 2017/18, but the increase in the percentage has been greater since 2017/18.
• In Hull, it is estimated that five women per year will have chronic severe mental illness within the perinatal period. It is further estimated that around the same number will have postpartum psychosis, and approximately 100 will have severe depressive illness, 100 post traumatic stress disorder, 350-500 mild to moderate depressive illness and anxiety states, and 500-1,000 with adjustment disorders and distress.
• There was a decrease in the number of new birth visits completed within 14 days and 6-8 week reviews in Hull between 2021/22 and 2022/23, but despite the decrease, the percentage with reviews was statistically significantly higher in Hull compared to England. These reviews are a very good opportunity to pick up any problems with not just the infant, but the mother (and father) too.
• Good antenatal care and support can identify potential problems early, but poor care can increase the risks to both mother and baby.

The Population Affected – Why Is It Important?

Good antenatal care and support can identify potential problems early, and provide information to aid informed choice. Poor antenatal care and care during labour and birth can increase the risks to both mother and baby. Good maternity services should respond to the physical, psychological, emotional and social needs of the women and her family in a structured and systematic way. Care should also be personalised so that it best fits with the needs of the mother, her baby and her family, and their circumstances.

There is a higher risk of adverse events in pregnancy and during labour and birth for women who are teenagers, who are older, who smoke, who are overweight, or who have other risk factors such as diabetes. The proportion of births to older women and women who are overweight has increased giving rise to an increase in the likelihood of adverse events. This has placed additional pressure on already stretched maternity services nationally.

Women who lack emotional and social support have been found to be at increased risk of perinatal mental health; having a poor relationship with a partner is also a risk factor for perinatal mental health. Infant mortality rates are higher among babies that are sole registered than for other registration types. As well as having a profound effect on the individual affected (often the mother but could be the partner), poor perinatal mental health has a strong effect on the whole family and can influence the bond established between parent and child, which can have long-lasting implications.

It is very common for women to feel anxious about labour and birth. Worries about labour pains, interventions and the uncertainty of the process are not unusual. But for some women, the fear of labour and birth can be so overwhelming that it overshadows their pregnancy and affects daily functioning. This severe fear of birth is called tokophobia – which literally means a phobia of childbirth. And for some women, this also includes a dislike or disgust with pregnancy.

Tokophobia can be split into two types – primary and secondary. Primary tokophobia occurs in women who have not given birth before. For these women, a fear of birth tends to come from traumatic experiences in their past – including sexual abuse. It can also be linked to witnessing a difficult birth or listening to stories or watching programmes which portray birth as embarrassing or dangerous. Whereas women who suffer from secondary tokophobia, tend to have had a previous traumatic birth experience which has left them with a fear of giving birth again. It is difficult to say how common tokophobia is. Research suggests that between 2.5% and 14% of women are affected by tokophobia. But some researchers believe this figure could be as high as 22%.

There are a number of antenatal and newborn screening programmes in place in the UK. Tests in pregnancy and in the newborn are designed to help make the pregnancy safer, check and assess the development and wellbeing of the woman and her baby, and screen for particular conditions. Nationally there are several screening programmes for pregnant women, although most are only for specific women at increased risk. Data on the uptake of screening for HIV, syphilis, hepatitis B, and sickle cell and thalassaemia for pregnant women and fetal anomaly screening is available for England and the Yorkshire and Humber at The Office for Health Improvement & Disparities’ Fingertips, although this information is not available at local authority level. Further information can be found under Screening and Vaccinations within Children and Young People.

The Hull Picture

The Office for Health Improvement & Disparities’ Fingertips included information on the percentage of women who accessed maternity care early in their pregnancy, and at this first antenatal (booking) appointment, the percentage who were taking folic acid supplements prior to becoming pregnant, who were obese and who were current smokers for the financial year 2018/19. However, the information is no longer presented on Fingertips.

For 2018/19, women in Hull compared to England are much less likely to take folic acid supplements before becoming pregnant (14% versus 27%), and are more likely to be obese with a body mass index of 30+kg/m² (31% versus 22%) or smoke (23% versus 13%) in early pregnancy (as recorded at the time of their first antenatal (booking) appointment), although women in Hull have relatively high percentages who book / register for local maternity care services within 10 completed weeks of their pregnancy compared to England (64% versus 58%). Most women in Hull who are recorded as smokers during their first antenatal appointment, continue to smoke during their entire pregnancy. In 2022/23, just under one in five (18.5%) of women recorded their smoking status as a current smoker at the time of the delivery compared to 8.8% for England. Further information is presented within Smoking in Pregnancy within Pregnancy and Infants within Children and Young People.

More detailed information for the financial year 2016/17 is available from local maternity services on the mother’s weight classification at their initial antenatal (booking) appointment. For 2016/17, 1,153 (28%) were overweight (BMI 25-29.9kg/m²), 617 (15%) had a BMI 30-34.9kg/m², 313 (8%) had a BMI 35-39.9kg/m² and 184 (4.5%) had a BMI 40+kg/m². So 2,267 women out of 4,063 (56%) were overweight which included 930 (27%) who were obese which included 4.5% who were morbidly obese.

Obesity and smoking in early pregnancy (at their first antenatal appointment) is worse in Hull compared to other local authorities across the Yorkshire and Humber region, with Hull having the highest percentage (31%) of women that were obese in early pregnancy in 2018/19, 38% higher than for England and 27% higher than for the region.

Almost one-quarter (23%) of pregnant women were smoking as recorded during their first antenatal appointment in Hull in 2018/19, the fourth highest percentage in the Yorkshire and Humber region, 81% higher than for England and 33% higher than for the region.

There has been some year-on-year variability in the percentage of Hull women who are recorded as current smokers at the time of delivery. The percentage of smoking throughout pregnancy has reduced only slightly over the last decade, but the reduction has been relatively slow. The percentage remained relatively unchanged – at around 21% between 2014/15 and 2020/21, but decreased to 18.5% between 2020/21 and 2022/23.

In contrast, the percentage of women who were recorded as current smokers at the time of delivery across England and the region has shown a consistent decline over time.

During 2022/23, 525 Hull women at the time of their delivery were current smokers.

Further information is presented within Smoking in Pregnancy under Pregnancy and Infants under Children and Young People.

Further information is available on births to mothers from minority ethnic groups, multiple births, premature births and low birth weight within Births and Infant Health in Pregnancy and Infants under Children and Young People. Information relating to fertility rates and abortion rates is available within Sexual and Reproductive Health in Health Factors under Adults.

The age distribution of mothers in Hull is also lower compared to England with a higher percentage of mothers aged under 18 years (1.9% versus 0.6%) and a lower percentage of mothers aged 35+ years (15.8% versus 24.4%) for 2022/23.

Further information relating to under 18 conceptions can be found within Under 18 Conceptions in Health Factors under Children and Young People, and further information relating to the average age of mothers and the changes over time can be found within Births and Infant Health under Pregnancy and Infants under Children and Young People.

The percentage of teenager mothers in Hull has almost halved between 2010/11 and 2020/21 from 2.8% to 1.1%, although there have been increases since then to 1.9% for 2022/23.

More information on teenage mothers can be found within Under 18 Conceptions under Health Factors under Children and Young People.

Hull has among the lowest percentage of deliveries to mothers aged 35+ years across the Yorkshire and Humber region for 2022/23.

However, there has been an increase in the percentage of deliveries among older women in Hull over time from 9.2% in 2010/11 to 15.8% for 2022/23.

The percentage of caesarean sections in Hull is statistically significantly lower than England for 2022/32, although the absolute difference in the percentages is relatively small (35.9% versus 37.8%).

The percentage of caesarean section births has increased over time in both Hull and England from around one in four births in 2014/15 to more than one in three births in 2022/23.

The increase in the percentage of caesarean section births has increased in Hull at a very similar rate to that observed in the region and for England. The rate increased between 2013/14 and 2017/18, but the increase in the percentage has been greater since 2017/18.

For 2022/23, the percentage of new birth visits completed within the first 14 days and the percentage of 6-8 week visits completed within the time period are high in Hull compared to England and the Yorkshire and Humber region, and both are statistically significantly higher in Hull compared to England. These early visits are very important so that any problems can be picked up quickly especially those relating to maternal emotional and mental wellbeing.

The percentage of new birth visits completed within 14 days in Hull was significantly lower than England during 2017/18 and 2018/19, but increased from 82.9% in 2017/18 to a high of 89.5% in 2020/21. Despite decreases in both 2021/22 and 2022/23, the percentage in Hull is statistically significantly higher than England in the latest 2022/23 year.

The percentage of infants receiving a 6-8 week review in Hull was similar to England for 2017/18 (84.6% and 84.3% respectively), but the percentage increased in Hull to a high of 93.0% in 2019/20. Whilst the rate fell slightly in Hull for 2020/21 and 2021/22 with a greater decrease between 2021/22 and 2022/23, the percentage of infants receiving their 6-8 week review is statistically significantly higher in Hull compared to England for the latest year 2022/23.

The Office for Health Improvement & Disparities’ Fingertips gives the estimated number of women with perinatal mental health. The estimates for Hull (and other local authorities) are based on applying the national prevalence estimates to the numbers of women giving birth in the local authority (including stillbirths), and do not take into consideration socio-economic or demographic differences or anything else which is likely to cause variation across areas.

In 2017/18, it was estimated that between 390 and 781 women in Hull would have adjustment disorders and distress in the perinatal period, and between 260 and 390 women would have mild to moderate depressive illness and anxiety in the perinatal period. There are concerns over the data quality of these indicators, and therefore they should be used as a guide to the level of need for perinatal mental health services. The estimates have been given as a range rather than an absolute number because of the data quality issues.

The national prevalence of adjustment disorders and distress in the perinatal period is estimated to range between 150 to 300 per 1,000 maternities, and mild to moderate depressive illness and anxiety in the perinatal period is estimated to range between 100 and 150 per 1,000 maternities.

It was estimated in 2017/18, that five women in Hull would have chronic severe mental illness, 78 would have post-traumatic stress disorder and 78 would have severe depressive illness in the perinatal period. However, there are concerns over the data quality of these indicators, and therefore they should be used as a guide to the level of need for perinatal mental health services.

The national prevalence of chronic severe mental illness in the perinatal period is estimated to be around 2 in 1,000 maternities, 20 in 1,000 maternities for post-traumatic stress disorder in the perinatal period, and 30 in 1,000 maternities for severe depressive illness in the perinatal period.

Strategic Need and Service Provision

The Better Births national maternity review states that “every women, every pregnancy, every baby and every family is different. Therefore, quality services (by which we mean safe, clinically effective and providing a good experience) must be personalised”. The vision for maternity services across England is “for them to become safer, more personalised, kinder, professional and more family friendly; where every woman has access to information to enable her to make decisions about her care; and where she and her baby can access support that is centred around their individual needs and circumstances. And for all staff to be supported to deliver care which is women centred, working in high performing teams, in organisations which are well led and in cultures that promote innovation, continuous learning, and break down organisational and professional boundaries”. The national Maternity Transformation Programme seeks to achieve the vision set out in Better Births working across nine work streams: (1) transforming the workforce; (2) sharing data and information; (3) harnessing digital technology; (4) reforming the payment system; (5) promoting good practice for safer care; (6) improving prevention; (7) improving access to perinatal mental health services; (8) supporting local transformation; (9) increasing choice and personalisation.

The NHS Long Term Plan states that the NHS will accelerate action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025 with the following:

• Roll out of the Saving Babies Lives Care Bundle to reduce stillbirth rates.
• Support establishment of Maternal Medicine Networks to ensure women with acute and chronic medical problems have timely access to specialist advice and care at all stages of their pregnancy.
• Maternity Incentive Scheme will reward the delivery of 10 key maternity safety actions through a Clinical Negligence Scheme for Trusts rebate.
• A focus of preventing pre-term births and development of specialist pre-term birth clinics across England.
• Recommendations from the National Maternity Review: Better Births are being implemented through Local Maternity Systems bringing together organisations to ensure women and their families received seamless care.
• Ensure every trust in England with a maternity and neonatal service will be part of the National Maternity and Neonatal Health Safety Collaborative.
• Continued development and launch of carer teams across the country with the aim that one-fifth of women will have the opportunity to have the same midwife caring for them throughout their pregnancy, during birth and postnatally.
• The NHS will continue to improve how it learns lessons when things go wrong and minimise the chances of them happening again with a Perinatal Mortality Review Tool to support high quality reviews into each stillbirth and neonatal death.
• Continued roll out of maternity digital care records.
• Improve access to postnatal evidence-based psychological therapies within specialist perinatal mental health services so that they also include parent-infant, couple, co-parenting and family interventions.
• Improved access to postnatal physiotherapy to support women who need it to recover from birth.
• For all maternity services to deliver accredited evidence-based infant feeding programmes if they do not already do so.
• Redesign and expand neonatal critical care services to improve the safety and effectiveness of services and the experience of families. In particular addressing the shortage of neonatal capacity.
• Develop the expert neonatal nursing workforce.
• Enhance the experience of families during the worrying period of neonatal critical care.

In addition to the five universal core contacts as part of the Healthy Child Programme which every family has access to, families in Hull also receive an additional visit at 3-4 months taking the universal contacts to six. This provides more support to families, and more opportunity to highlight any health and wellbeing needs of the family earlier.

Maternity staff, health visitors and other services supporting women need to be aware of tokophobia, and be able to offer the best possible support to any women experiencing this. The effect on the mother, baby and their relationship and bonding could be severely affected if this is not addressed. In Hull, there is a care pathway for tokophobia so women can get the support that they need.

Work needs to continue to reduce the under 18 conception rate, as well as reduce the number of women who are obese or who smoke, with a need to provide help and advice prior to pregnancy to attempt to reduce these risks (although recognising that not all pregnancies are planned). Further information is available within Under 18 Conceptions, Smoking in Pregnancy, and within Healthy Weight and Smoking in Lifestyle Factors within both Adults and Children and Young People.

Identifying risks and intervening early to improve maternal health and wellbeing, improving birth preparation, promoting positive parenting skills, and creating an environment for children and young people that builds self-esteem and resilience, with good emotional health. Early help and intervention for all families should be timely, accessible and appropriate for their circumstances. Hull’s Early Help programme aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in a coordinated way. The framework outlines the approach to ensure the collaboration and alignment of services, and that early help may be ‘early in life or at the earliest opportunity’ which is also part of the day job, helpful, non-stigmatising, preventative, targeted and tailored. There are four thresholds of need: (i) no additional needs beyond universal provision / services; (ii) additional needs involving prevention and early help; (iii) complex needs involving a targeted response of early help and interventions; and (iv) risk of significant harm which includes child protection procedures and safeguarding services. 

Resources

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Maternity Services Liaison Committees, An introduction to maternity services in the NHS, 2014, The Office for Health Improvement & Disparities (formerly Public Health England): London.

Cumberlege, J. and National Maternity Review, Better Births: Improving outcomes of maternity services in England.  A Five Year Forward View for maternity care. 2016, National Maternity Review: London.

NHS England, Maternity Transformation Programme. 2016, NHS England: London.

NHS Improving Care. Improving Access to Perinatal Mental Health Services in England – A Review, 2017.

Joint Commissioning Panel for Mental Health Guidance for Commissioners guidance for commissioners of perinatal mental health services report published in November 2012

NHS Maternity Statistics, England 2019-20. https://digital.nhs.uk

NHS Long Term Plan 2019. https://www.longtermplan.nhs.uk/

Tokophobia. https://www.hull.ac.uk/work-with-us/more/media-centre/news/2020/tokophobia-is-an-extreme-fear-of-childbirth-heres-how-to-recognise-and-treat-it

Updates

This page was last updated / checked on 19 June 2024.

This page is due to be updated / checked in December 2024.