This report from the National Maternity and Perinatal Audit (NMPA) is based on births in NHS maternity services in England, Scotland and Wales during 2023. It found that the rate of babies born small for gestational age at or after 40 weeks has reduced in recent years, going from 55.4% in 2015/16 to 42.6% in 2023.
2023 saw the lowest number of births in England and Wales since 1977
The report also shows a shift in the mode of births over the last five years, with a decrease in vaginal births and an increase in caesarean births. Further findings related to the mode of birth include:
One in seven (14.2%) births following a previous caesarean birth were vaginal (VBAC), which is lower than previously reported (24.5% in 2016/17 and 22.5% in 2018/19)
The rate of eligible women who try for a VBAC also fell (26.3% in 2023, compared with 40.0% in 2016/17 and 38.0% in 2018/19)
Around 1 in 3 women and birthing people experienced an induction of labour.
This report states that these changes lead to increased demands on maternity services workforce and resources, with the increase in interventions possibly impacting postpartum recovery – and so further understanding, to support planning, is recommended.
Other key findings include the fact that there was striking variation in the rates of skin-to-skin contact between English Trusts (not available in Scottish or Welsh datasets). The report states that this may be a reflection of uncertainty around what constitutes meaningful skin-to-skin contact. As such, the NMPA recommends the development of a meaningful and consistent measure for skin-to-skin contact, with a request to document reasons for non-occurrence.
Recognising the importance of timely antenatal care, the audit also explored the rate of late booking. In 2023, 1 in 4 people attended their first appointment with a midwife after 10+0 weeks of gestation (NICE recommendation), with variation among providers and among nations (1 in 5 in Wales, and 1 in 3 in Scotland).
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