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NHS North Tyneside CCG Maternity care research September 2013 Delivered by Joanne Loughlin-Ridley.

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Presentation on theme: "NHS North Tyneside CCG Maternity care research September 2013 Delivered by Joanne Loughlin-Ridley."— Presentation transcript:

1 NHS North Tyneside CCG Maternity care research September 2013 Delivered by Joanne Loughlin-Ridley

2 Project background This section of the report provides detail on the research objectives, methodology and sample, providing context behind the insight.

3 Explain was commissioned in early 2012 by NHS North of Tyne to carry out a comprehensive evaluation of maternity care services across the North East The research detailed within this report aimed to build upon the qualitative insight that was completed and delivered to NHS North of Tyne in April 2012 An on-street survey was commissioned by NHS North Tyneside CCG, to engage a random sample of local ‘mothers’ and ‘future mothers’ – ‘Mothers’ includes women whose youngest child is five years or younger, and ‘future mothers’ includes pregnant women and those without children that plan to have a family of their own in the future – Quotas / targets were set for the survey sample based on age using the most up to date birth data available publically Fieldwork took place across a four week period, ending in early September 2013. Alongside the on-street approach, researchers were able to flexibly attend relevant sessions at local children’s centers as a means to gain access to the eligible target audience Project background

4 As with any data collection where a sample is drawn to represent a population, there is a potential difference between the response from the sample and the true situation in the population as a whole (a census). This is known as a standard error which is estimated using statistical calculations based on the sample size and the population size, normally expressed as a confidence interval for the results To achieve 100% accuracy in results would require the entire population to participate (a census). The usual confidence interval used in market research is 95% which means that you can be confident that in 19 out of 20 instances the actual population behaviour will be within the confidence interval range. The table below gives an indication of the 95% confidence interval for the data within this report at different sample sizes For example, if a result was 50% we can be confident that the true result if a census was completed for an 1100 sample survey would be actually ±3.0 (therefore between 47% - 53%) Please also note that respondents that did not or could not answer a question were removed from the data and therefore the base size in charts fluctuates from question to question Project background

5 1,145 took part in the on-street survey, including 595 mothers and 553 future mothers 4% of mothers and future mothers indicated they suffered a long-term illness / disability 7% of future mothers were pregnant at the point of interview 46% of mothers had only one child, meaning 54% were ‘multiple mothers’ 75% of mothers had a youngest child under 24 months, Project background

6 Whilst a target was set for an equal proportion of interviews to be carried out across the four areas within North Tyneside, researchers found it challenging to locate eligible women to take part in the North West area specifically Analysis has revealed interesting variations in response when comparing residents from the West (North West and South West) to the East (North East and South East) and so throughout this report comparisons are made on this basis Project background

7 Antenatal care Within this section of the report you will find details as to the quantitative insight generated from the mothers research which focused on antenatal care. Please note that future mothers were not asked questions relating to antenatal care on the basis that previous insight had confirmed a lack of knowledge and therefore expectations.

8 The majority of mothers had experienced their most recent antenatal care in North Tyneside Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their antenatal care experience that would have made it better Unprompted there was no evidence of a consistent area to improve and no significant variation found between care in Newcastle, North Tyneside and Northumberland Antenatal care Nothing /unsure (306 = 52%) More appointments (39 = 7%) More information (28 = 5%) Attitude of staff (22 = 4%) More hospital checks/scans (21 = 4%) More support/advice (15 = 3%) Closer to home (13 = 2%) See same midwife (13 = 2%)

9 Antenatal care ‘Better staff, as they are not very friendly’ ‘More classes throughout pregnancy, start them at an earlier stage of pregnancy’ ‘A consistent midwife throughout pregnancy’ ‘Every time I tried to discuss the birthing plan it was put off’ ‘It would have been better to stay at North Tyneside as I was taken from hospital to hospital’ ‘For someone to see me close to home’ ‘Have more scans when you have complications’ ‘More information in early stages and more check ups’ Nothing /unsure (306 = 52%) More appointments (39 = 7%) More information (28 = 5%) Attitude of staff (22 = 4%) More hospital checks/scans (21 = 4%) More support/advice (15 = 3%) Closer to home (13 = 2%) See same midwife (13 = 2%)

10 A series of statements were given to mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’) No significant variations were found by age, socio-economic group, number of children or where previous experience of antenatal care had been Antenatal care

11 When comparing responses from mothers that lived in the West to those that lived in the East, across three of the statements shown below there was significant variation found with mothers in the West more likely to ‘strongly agree’ and give 10 out of 10 Antenatal care *significant variations are circled in the graph

12 Mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important to them overall in regards to antenatal care With the exception of mothers aged 16-19, all profiles rated ‘Partners being given advice and information to help them prepare’ to be the LEAST important overall – Least important to 16-19s was ‘Having opportunities to meet other mothers’ (48%) Antenatal care

13 Variation in response was found for four of the statements rated in terms of what was MOST and LEAST important, when comparing responses by the area of residence and the number of children mothers had Antenatal care

14 Labour and delivery care Within this section of the report you will find details as to the quantitative insight generated from the mothers and future mothers research which focused on labour and delivery care. Please note that the sample of mothers and future mothers has also been combined within this section to give indications of trends by profile on a large sample base of over 1,100.

15 The majority of mothers had experienced their most recent labour and delivery care in Newcastle Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their labour and delivery care experience that would have made it better Unprompted there was no evidence of a consistent area to improve Those that had their care in Northumberland were more likely to state ‘Closer to home’ Labour and delivery care Nothing / unsure (268 = 45%) Attitude of staff / communication (60 = 10%) More midwives (33 = 6%) Facilities / hospital policies (24 = 4%) Early admittance (21 = 4%) Pain relief choice / administration (22 = 4%) Same midwife (14 = 2%) Closer to home (12 = 2%) Caesarean (10 = 2%)

16 Labour and delivery care ‘I would prefer a private room next time’ ‘Nicer midwives, they have bad manners’ ‘Same midwife, I had 3 different ones’ ‘More staff to assist you to be more supportive’ ‘Not to be sent home when in labour’ ‘Have more pain relief ’ ‘I would rather have been closer to home than going to Wansbeck’ ‘Give me more time to give birth instead of getting a C section’ ‘The same midwife throughout labour’ ‘The staff didn't care about me they just left me to get on with it’ ‘You shouldn't be sent home when your waters have broke’ Nothing / unsure (268 = 45%) Attitude of staff / communication (60 = 10%) More midwives (33 = 6%) Facilities / hospital policies (24 = 4%) Early admittance (21 = 4%) Pain relief choice / administration (22 = 4%) Same midwife (14 = 2%) Closer to home (12 = 2%) Caesarean (10 = 2%)

17 A series of statements were given to mothers and future mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’) Labour and delivery care

18 Across ten of the statements there was variation evident between mothers and future mothers in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10 Labour and delivery care *significant variations are circled in the graph

19 Across six of the statements there was also variation evident between mothers and future mothers in terms of the proportion that ‘strongly disagreed’ and gave 1 out of 10 Labour and delivery care *significant variations are circled in the graph

20 Across 11 of the statements a significantly higher proportion of mothers living in the West ‘strongly agreed’ and gave 10 out of 10 Labour and delivery care *significant variations are circled in the graph

21 Across five of the statements there was variation found in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10, when looking at the response of mothers in terms of where they had most recently experienced labour and delivery care Labour and delivery care *significant variations are circled in the graph

22 Labour and delivery care Across four of the statements a trend was found whereby the younger the respondent, the higher the proportion that ‘strongly agreed’ and gave 10 out of 10 *significant variations are circled in the graph

23 Across six of the statements there was variation found by socio-economic group in terms of the proportion rating ‘strongly agree’ and giving 10 out of 10 Labour and delivery care *significant variations are circled in the graph

24 Labour and delivery care Across six of the statements variation was found by area of residence, age and socio- economic group in terms of the proportion that ‘strongly disagree’ and gave 1 out of 10 *significant variations are circled in the graph

25 Mothers and future mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important overall in regards to labour and delivery care Labour and delivery care

26 Variation in response was found for six of the statements rated in terms of what was MOST and LEAST important, when comparing responses by age and area of residence Labour and delivery care *significant variations are circled in the graph

27 Following a description of what it would mean to give birth at home, in a midwifery led unit, a maternity care unit and a birthing centre, mothers and future mothers were asked to indicate which option they would choose if giving birth in the future First time mothers were more likely than multiple mothers to opt for a ‘Birthing centre’ (21% V 13%), and were less likely to select ‘Home’ (8% V 13%) Respondents from the West were more likely to opt for a ‘Birthing centre’ (21% V 12%) Labour and delivery care *significant variations are circled in the graph

28 Labour and delivery care Home (95 = 9% overall) Midwifery led unit (169 = 15% overall) Maternity care unit (682 = 61% overall) Birthing centre (177 = 16% overall) Comfortable / relaxing (63 = 66%) When asked to explain the reason for their choice, the following themes were found Family to be there (15 = 16%) Don’t like hospitals (7 = 7%) Convenience (4 = 4%) No intervention (3 = 3%) Previous experience (2 = 2%) Level of care / staff (51 = 30%) Homely / relaxed (42 = 25%) Previous experience (20 = 12%) Facilities (28 = 17%) Closer to home (21 = 12%) Recommended (10 = 6%) Clinical staff on-hand (189 = 28%) No choice (risk) (46 = 7%) Previous experience (30 = 4%) The ‘norm’ (8 = 1%) Recommendation (10 = 1%) Atmosphere (53 = 30%) Just ‘in case’ (22 = 12%) Previous experience (21 = 12%) Level of care / staff (18 = 10%) Natural (8 = 5%) Partner can stay (7 = 4%) Recommendation (3 = 2%) Private (4 = 2%) Facilities (23 = 13%) Just ‘in case’ (185 = 27%) Facilities (120 = 18%) Pain relief (97 = 14%) Convenience (13 = 2%)

29 Labour and delivery care Home (95 = 9% overall) Midwifery led unit (169 = 15% overall) Maternity care unit (682 = 61% overall) Birthing centre (177 = 16% overall) Comfortable / relaxing (63 = 66%) When asked to explain the reason for their choice, the following themes were found Clinical staff on-hand (189 = 28%) Atmosphere (53 = 30%) Just ‘in case’ (185 = 27%) ‘It is more natural and homely’ ‘It will be more comfortable at home’ ‘There is more one to one support’ ‘There are doctors on duty’ ‘It is more relaxed at home’ ‘I would feel more comfortable having family with me’ ‘It was comfortable and has brilliant staff, it wasn't like a cattle market’ ‘It has a homely feel and a nicer environment’ ‘There are doctors there ’ ‘I would feel safer’ ‘In case something goes wrong ’ ‘It is a more relaxing place’ ‘It has a more relaxed atmosphere and it is more like home’ ‘They are more caring’ Level of care / staff (51 = 30%) Homely / relaxed (42 = 25%)

30 Labour and delivery care Not a home birth (1028 = 92%) Not a midwifery led unit (954 = 85%) Not a maternity care unit (441 = 39% ) Not a birthing centre (946 = 84% ) When asked why they would not choose the other options, the following themes were found Just ‘in case’ (448 = 44%) No clinicians (92 = 9%) Pain relief (73 = 7%) Scared (62 = 6%) Messy (60 = 6%) Couldn’t (40 = 4%) Inconvenient (35 = 3%) Unsure (80 = 8%) No equipment (36 = 4%) Transfer time (32 = 3%) Not sterile (31 = 3%) Negative (31 = 3%) Pain relief (266 = 28%) No clinicians (161 = 17%) Transfer (80 = 8%) Dislike hospitals (45 = 5%) Facilities / equipment (45 = 5%) Couldn’t (40 = 4%) Just ‘in case’ (38 = 4%) Prefer hospital (27 = 3%) Not 1 st choice (16 = 2%) One to one care (11 = 1%) Dislike hospitals (98 = 22%) Unsure (90 = 20%) Too busy (86 = 20%) Impersonal care (39 = 9%) Not 1 st choice (32 = 7%) Unnecessary (21 = 5%) Too far away (16 = 4%) Unsure (192= 20%) No clinicians (90 = 10%) Pain relief (50 = 5%) Prefer hospital (30 = 3%) Transfer (51 = 5%) Unfamiliar (39 = 4%) Not 1 st choice (18 = 2%) Just ‘in case’ (18 = 2%) Facilities (27 = 3%) Dislike hospitals (39 = 4%) Couldn’t (22 = 2%) Too far away (17 = 2%)

31 Labour and delivery care When asked why they would not choose the other options, the following themes were found Just ‘in case’ (448 = 44%)Pain relief (266 = 28%) No clinicians (161 = 17%) Dislike hospitals (98 = 22%) Unsure (90 = 20%) Too busy (86 = 20%) Unsure (192= 20%) No clinicians (90 = 10%) ‘No reason’ ‘It is too clinical ’ ‘I don't think it is as safe ’ ‘Limited pain control’ ‘I would be scared things would go wrong ’ ‘In case things went wrong’ ‘In case of any complications’ ‘There is not enough pain relief’ ‘Not enough medical back up staff if needed’ ‘There are no doctors ’ ‘It is a hospital environment’ ‘No reason’ ‘It is too busy’ ‘There is no doctor on duty, would not feel as safe’ ‘There are no doctors there’ ‘It is too busy it is like a cattle market ’ ‘There are not as many medical staff ’ ‘The staff are not experienced enough’ Not a home birth (1028 = 92%) Not a midwifery led unit (954 = 85%) Not a maternity care unit (441 = 39% ) Not a birthing centre (946 = 84% )

32 When provided with a list of current options in the North East, the RVI’s maternity care unit was found to be most preferable by both mothers and future mothers First time mothers were more likely than multiple mothers to opt for ‘Birthing centre – RVI’ (21% V 15%) There was no significant variation found by age when comparing responses Labour and delivery care *significant variations are circled in the graph

33 When comparing choice of service type by the location of the mothers most recent experience of labour and delivery care, variation was found Mothers that most recently experienced labour and delivery care in North Tyneside were more likely to opt for a ‘Midwifery led unit’ and were less likely to opt for a ‘Maternity care unit’ Mothers that most recently experienced labour and delivery care in Newcastle, were more likely to opt for a ‘Birthing Centre’ Labour and delivery care *significant variations are circled in the graph

34 Comparing response by area of residence and socio-economic group revealed variation Labour and delivery care *significant variations are circled in the graph

35 Labour and delivery care When asked why they had chosen that specific option, the following themes were found RVI, maternity care unit (553 = 49%) Rake Lane, midwifery led unit (248 = 22%) RVI, birthing centre (172 = 15%) Home (83 = 7%) Wansbeck, maternity care unit (67 = 6%) Cramlington, maternity care unit (17 = 2%) Past experience / familiarity (47 = 19%) Recommendation (12 = 5%) Past experience / familiarity (24 = 14%) Quality of care (10 = 6%) Good reputation (15 = 9%) Partners can stay (3 = 2%) Close to home (137 = 55%) Atmosphere (29 = 12%) Close to home (9 = 5%) Atmosphere (35 = 20%) Only birthing centre (11 = 6%) Clinicians nearby (16 = 9%) Quality of care (41 = 17%) Comfortable / relaxing (68 = 82%) Family can be there (9 = 11%) Previous experience / familiarity (42 = 63% Close to home (14 = 21% Reputation / better than others (10 = 15% Clinicians on- hand (6 = 9% It’s a new unit (10 = 59%) Close to home (9 = 53% Specialists / doctors on-hand (56 = 10%) Big / good hospital (55 = 10%) Previous experience / familiarity (55 = 10%) Safer (26 = 5%) Good reputation / better than others (85 = 15%) Facilities (67 = 12%) Quality of care (40 = 7%) Close to home (54 = 10%)

36 Labour and delivery care When asked why they had chosen that specific option, the following themes were found RVI, maternity care unit (553 = 49%) Rake Lane, midwifery led unit (248 = 22%) RVI, birthing centre (172 = 15%) Home (83 = 7%) Wansbeck, maternity care unit (67 = 6%) Cramlington, maternity care unit (17 = 2%) Specialists / doctors on-hand (56 = 10%) Big / good hospital (55 = 10%) Previous experience / familiarity (55 = 10%) ‘Family had their babies there, they say it's good and it has a better reputation’ ‘It is a better hospital overall’ ‘Rake lane has a bad reputation’ ‘There are doctors on hand if needed’ ‘They have excellent staff’ ‘Excellent after care’ ‘Has everything on hand’ ‘I had a good experience the first time’ ‘I would feel safe’ ‘It has got all the things you need’ ‘It is the closest maternity care hospital’ ‘It is a bigger hospital’ ‘It is the best option’ Good reputation / better than others (85 = 15%) Facilities (67 = 12%) Quality of care (40 = 7%) Close to home (54 = 10%) Safer (26 = 5%)

37 The maternity care unit at the RVI was also most preferred for mothers and future mothers, should they need to stay within a service for several days following delivery First time mothers were more likely than multiple mothers to opt for ‘Birthing centre – RVI’ (12% V 7%), whilst being less likely to opt for ‘Maternity care unit – RVI’ (53% V 63%) There was no significant variation found by age or SEG when comparing responses Labour and delivery care *significant variations are circled in the graph

38 When comparing specific choice of service by the location of the mothers most recent experience of labour and delivery care, variation was found Mothers that most recently experienced labour and delivery care in North Tyneside were more likely to opt for ‘Rake Lane’ Mothers that most recently experienced labour and delivery care in Newcastle, were more likely to opt for a ‘RVI – maternity’ and ‘RVI – birthing centre’ Mothers that most recently experienced labour and delivery care in Northumberland, were more likely to opt for ‘Wansbeck’ Labour and delivery care *significant variations are circled in the graph

39 There was variation evidence in choice of service when comparing responses by area of residence Significantly more respondents living in the East opted for ‘Rake Lane’ and ‘Wansbeck’ Significantly more respondents living in the West opted for the ‘RVI’ (maternity care unit and birthing centre) Labour and delivery care *significant variations are circled in the graph

40 Labour and delivery care When asked why they had chosen that specific option, the following themes were found RVI, maternity care unit (694 = 61%) Rake Lane, midwifery led unit (229 = 20%) RVI, birthing centre (94 = 8%) Wansbeck, maternity care unit (83 = 7%) Cramlington, maternity care unit (35 = 3%) Good reputation / better than others (150 = 22%) Previous experience / familiarity (68 = 10%) Quality of care (57 = 8%) Specialists / doctors on- hand (188 = 27%) Facilities (144 = 21%) Close to home (84 = 12%) Atmosphere (6 = 1%) Atmosphere (39 = 16%) Previous experience / familiarity (27 = 11%) Quality of care (27 = 11%) Close to home (149 = 60%) Facilities (14 = 6%) Quality of care (14 = 15%) Atmosphere (35 = 37%) Good reputation (8 = 9%) Clinicians nearby (26 = 28%) Only birthing centre (8 = 9%) Close to home (16 = 19%) Quality of care (14 = 17%) Previous experience / familiarity (18 = 22%) Atmosphere (14 = 17%) Specialists / doctors on-hand (16= 46%) Close to home (7 = 20%) It’s a new unit (4 = 11%) Specialists / doctors on-hand (12= 14%)

41 Labour and delivery care When asked why they had chosen that specific option, the following themes were found RVI, maternity care unit (694 = 61%) Rake Lane, midwifery led unit (229 = 20%) RVI, birthing centre (94 = 8%) Wansbeck, maternity care unit (83 = 7%) Cramlington, maternity care unit (35 = 3%) Good reputation / better than others (150 = 22%) Previous experience / familiarity (68 = 10%) Quality of care (57 = 8%) Specialists / doctors on- hand (188 = 27%) Facilities (144 = 21%) Close to home (84 = 12%) Atmosphere (6 = 1%) ‘There are more doctors there ’ ‘There are specialists on hand’ ‘It has the best reputation ’ ‘It is a better hospital ’ ‘There are more specialist staff ‘They have everything there’ ‘It has everything you need ’

42 Postnatal care Within this section of the report you will find details as to the quantitative insight generated from the mothers research which focused on postnatal care. Please note that future mothers were not asked questions relating to postnatal care on the basis that previous insight had confirmed a lack of knowledge and therefore expectations.

43 The majority of mothers had experienced their most recent postnatal care in North Tyneside Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their postnatal care experience that would have made it better Unprompted there was no evidence of a consistent area to improve and no significant variation found between care in Newcastle, North Tyneside and Northumberland Postnatal care Nothing / unsure (293 = 49%) More advice/ support/information (56 = 9%) Earlier follow-ups / longer visits (51 = 9%) Staff attitude / training (24 = 4%) Same midwife / health visitor (23 = 4%) Hospital policies (21 = 4%)

44 Postnatal care ‘Friendly midwife where you can feel comfortable with them as they are the same one’ ‘I was left on my own, there was no space in Rake Lane for me, more help with breastfeeding’ ‘At the RVI I didn't like being on ward, I could not relax’ ‘More health visits after you get home’ ‘To see the midwife for a longer period of time at home’ ‘To be more aware of where I can get help after the birth’ ‘Midwife to be more caring after I got home’ ‘For the midwives to be more pleasant and to give more hands on help’ ‘To see the same midwife each time would be better’ ‘Just being allowed visitors anytime’ ‘For my partner to be able to stay with me longer after the baby is born’ ‘Help with breast feeding’ Nothing / unsure (293 = 49%) More advice/ support/information (56 = 9%) Earlier follow-ups / longer visits (51 = 9%) Staff attitude / training (24 = 4%) Same midwife / health visitor (23 = 4%) Hospital policies (21 = 4%)

45 A series of statements were given to mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’) There was no significant variations found by age or where the mothers had previously experienced postnatal care from Postnatal care

46 Across five of the statements variation was found by area of residence, socio-economic group and number of children mothers had, in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10 Postnatal care *significant variations are circled in the graph

47 Across five of the statements variation was found by area of residence, socio-economic group and number of children mothers had, in terms of the proportion that ‘strongly disagreed’ and gave 1 out of 10 Postnatal care *significant variations are circled in the graph

48 Mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important to them overall in regards to antenatal care With the exception of mothers living in the West, all profiles rated ‘Partners being given advice and information to help them care for the baby’ to be the LEAST important overall – Least important to mothers from the West was ‘Having opportunities to meet other mothers’ (30%) Postnatal care

49 Comparing results of MOST important, there were interesting variations found by area of residence and socio-economic group when looking at three statements in particular Postnatal care *significant variations are circled in the graph

50 Comparing results of LEAST important, there were interesting variations found by area of residence and the number of children mothers had, across four statements Postnatal care *significant variations are circled in the graph

51 Next steps Based on the quantitative insight, Explain has developed within this section of the report key considerations and recommendations for NHS North Tyneside CCG, to inform plans for the future.

52 Key considerations High levels of agreement were found across the maternity care journey in regards to what local women want from services (top five overall are displayed in the graph below) Whilst many mothers indicated ‘nothing’ could be improved about their experience, when looking across the whole of the maternity care journey, the most common theme in the literal comments collected calls for consistency in seeing the same health professional

53 Key considerations When asked to indicate what was MOST important, consistency in seeing the same health professional for antenatal and postnatal care stood out overall (top three shown below) Revealed as the LEAST important overall was ‘Partners being given advice and information to help them prepare’ in regards to antenatal care (50%), followed by postnatal care (36%)

54 Key considerations A majority of 61% would opt for a maternity care unit in the future, with high ratings given to statements regarding ‘doctors and specialists’ as well as ‘pain relief’ Most mothers (63%) had experienced labour and delivery care in Newcastle, a trend that is anticipated to continue with 64% overall opting for the RVI if giving birth in the future The RVI was found to have a strong and positive reputation, notably very popular with residents of the West as well as future mothers Variations found by demographic profiles as well as by location, confirm that a ‘truly ideal’ maternity care service would require a high level of flexibility and tailoring to the individual

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