Methodology & sources

Spontaneous vaginal birth rate

The proportion of births that happened vaginally without any assistance - no forceps, no ventouse, and not by caesarean section. Derived by subtracting the caesarean and instrumental delivery rates from 100%. A higher rate reflects a unit where more women birth without intervention, though this is strongly influenced by the case mix of pregnancies the unit looks after.

Caesarean section rate (total, emergency, elective)

The proportion of births delivered by caesarean section - an operation to deliver the baby through a cut in the abdomen and womb rather than through the vagina. We show three figures: the overall rate, the rate of emergency caesareans (unplanned, typically carried out when concerns arise during labour or pregnancy), and elective caesareans (planned in advance, for medical or maternal-choice reasons).

Sourced from NHS Hospital Episode Statistics, Provider Level Analysis.

Instrumental delivery rate

Instrumental deliveries use either forceps (metal instruments shaped like curved tongs placed around the baby's head) or ventouse (a suction cup attached to the baby's head) to help guide the baby out during the pushing stage of labour. They are used when a baby needs to be born quickly due to concerns about its wellbeing, or when the mother is too exhausted to push effectively. A higher instrumental delivery rate is common at teaching hospitals, where more complex presentations are referred and where trainees are being supervised in these skills. Instrumental delivery often prevents an emergency caesarean.

Induction of labour rate

Labour induction means starting labour artificially rather than waiting for it to begin on its own. This is done using prostaglandin pessaries (hormone gels or tablets placed in the vagina to soften and open the cervix), a procedure to break the waters, or a hormone drip (oxytocin) - or a combination of these.

Induction is offered for many reasons: a pregnancy that has gone significantly past its due date (post-dates pregnancy), gestational diabetes (a type of diabetes that develops during pregnancy and increases risks if left too long), pre-eclampsia (a condition causing high blood pressure in pregnancy that can be dangerous if untreated), or other concerns about the baby's growth or wellbeing. The induction rate reflects local policy, thresholds, and case mix - not quality of care on its own.

VBAC rate - vaginal birth after caesarean

A VBAC (pronounced "vee-back") is when a woman who has had at least one previous caesarean section gives birth vaginally. For most women this is a safe option, but it requires close monitoring during labour and access to an operating theatre in case of emergency. A higher VBAC rate at a unit reflects a culture that supports and facilitates women who want to attempt a vaginal birth after caesarean - and the monitoring facilities to do so safely. A lower rate may reflect a unit with a more cautious policy, or a higher proportion of women choosing a repeat caesarean.

Episiotomy rate

An episiotomy is a small surgical cut made to the opening of the vagina during birth to create more space and help the baby out. It may be performed to speed up a delivery when there are concerns about the baby, to assist an instrumental delivery, or to prevent a more serious uncontrolled tear. Episiotomy rates vary between units and between individual practitioners, and the balance between episiotomy and tear rates should be read together.

3rd and 4th degree perineal tear rate

The perineum is the tissue between the vaginal opening and the anus. During birth it stretches, and sometimes it tears. Tears are graded 1 to 4 by severity:

• Grade 1 - skin only, usually heals without stitches
• Grade 2 - skin and muscle, repaired with stitches
• Grade 3 - extends into the muscles around the anus
• Grade 4 - extends into or through the back passage (rectum)

Grades 3 and 4 - called obstetric anal sphincter injuries (OASI) - are the most serious and can cause long-term problems if not repaired correctly. We show the combined rate of 3rd and 4th degree tears. This rate is influenced by the proportion of instrumental deliveries at a unit (forceps deliveries carry a higher risk of severe tears) and by the skill and experience of practitioners in recognising and managing them.

Postpartum haemorrhage (PPH) rate

A postpartum haemorrhage is significant blood loss after giving birth. We show two thresholds: PPH of more than 500ml (moderate - about the volume of a standard wine bottle, and the level at which active management is typically started) and PPH of more than 1,000ml (severe - a major obstetric emergency requiring urgent treatment and sometimes blood transfusion). These rates are influenced by the complexity of births at the unit - twin births, prolonged labours, and placental complications all increase the risk of PPH regardless of care quality.

Stillbirth & neonatal death - comparator bands

A stillbirth is when a baby is born dead after 24 weeks of pregnancy. A neonatal death is when a baby born alive dies within the first 28 days of life. Both are rare events, and this rarity creates a statistical problem: at any individual hospital, the numbers in a single year are small enough that a random bad year could make a safe unit look dangerous, and vice versa.

For this reason, MBRRACE-UK does not publish raw rates for individual trusts. Instead, it uses a comparator band system. MBRRACE groups each trust with a set of similar units - matched by the characteristics of their populations, such as deprivation levels, the proportion of pregnancies in high-risk groups, and case complexity. Each trust is then assessed against this comparator group: is its rate statistically higher than expected, within the expected range, or lower than expected?

We show this band - not a raw number - which is exactly how MBRRACE themselves present the data, and for good reason. A tertiary centre (a large specialist hospital that receives the most critically ill babies from a wide region) will have a higher neonatal death rate than a small district general - not because it is worse, but because it is caring for the sickest babies. The comparator band corrects for this.

Friends & Family Test (FFT)

NHS England publishes monthly FFT data for all acute trusts. We use the maternity category and report the percentage of respondents who said they would recommend the service. The FFT covers four contact points: antenatal care, labour and birth, postnatal ward, and postnatal community. This figure combines responses across all four settings.

Not all trusts submit every month, and response rates vary considerably - a small unit may have fewer than 50 respondents in a given month, making the percentage volatile. A dash (-) means no data was submitted for the most recent period.

CQC maternity rating

The CQC inspects NHS trusts and rates five key questions for each service area: Safe (is care free from harm?), Effective (does care achieve good outcomes?), Caring (are staff compassionate and respectful?), Responsive (does the service meet people's needs?), and Well-led (is there good leadership and governance?). For maternity services, each is rated Outstanding, Good, Requires Improvement, or Inadequate. A combined maternity rating is produced from these five. We show the maternity-specific rating where available, or the overall trust rating where it is not. Ratings reflect the last inspection - CQC inspects on a risk-based schedule, typically every 2–5 years, so some ratings may be several years old.