Women’s experience of NHS maternity care is improving but almost one in four mothers are still being left alone during labour or birth, a major new survey reveals.

More mothers were satisfied with how they were looked after when they gave birth in England, in-depth research by the Care Quality Commission, the NHS care watchdog, has found.

Growing numbers of women were offered a choice of where to give birth, saw the same midwife during their antenatal care and were helped while they waited in hospital with their baby before going home.

However, childbirth campaigners warned that overdue improvements in the quality of maternity services should not disguise the fact that many women, often a majority, still do not get care standards pledged over a decade ago.

The NCT, a parenting charity, voiced alarm at the CQC’s finding that 23% of the 18,426 women surveyed were worried by being left without a midwife or doctor present during their labour or birth. That was only three percentage points fewer than the 26% who said the same when the same survey was undertaken in 2015.

“Encouragingly, the number of women left alone in labour has reduced. However, it is still of great concern that 23% of women are left alone during the birth of their baby, which can be a very frightening and dangerous experience,” said Elizabeth Duff, the NCT’s senior policy adviser.

“This reinforces the fact that staffing levels are low and midwives are being stretched to the limit, so we continue to call on the government to address this midwife shortage.”

NHS policy since 2010 has been that all women should always have a midwife or doctor with them during labour and birth to provide advice, reassurance and practical help. But shortages of midwives make that ambition difficult to fulfil. Midwives can end up looking after several women giving birth simultaneously, said Duff.

NCT research last year found that half of all births involve at least one “red flag” event, in which a lapse in safety could threaten the health of the baby, mother or both. Half of the £4.37bn of medical negligence claims lodged against NHS trusts every year involve childbirth, with the lifetime care costs of a brain-damaged baby now often reaching £20m.

The CQC also found that one in five (22%) women who had a “normal” (non-assisted) vaginal delivery had their legs raised in stirrups while they gave birth. Overall, 36% of all mothers who gave birth did so that way, 1% more than in 2015. That contravenes guidance from the National Institute for Health and Care Excellence (Nice), that women having “normal” births should do so standing up or squatting, and Duff says these findings represent “poor, poor practice.”

The results showed that maternity services were “moving in the right direction”, added Duff. However, “there is still a lot more work to be done to ensure all women receive the quality of care they need. In particular, we hope to see improvements in the continuity of care women receive postnatally, with 72% of new mothers reporting that they did not see the same midwife after leaving hospital.”

Since 2010, women have also in theory been able to choose between four different locations in which to give birth: at home, in a consultant-led obstetric unit or at a midwife-led unit based either at a hospital or elsewhere.

But while more women have been given more choice in that recently, many have only limited options and 15% were not offered any choice at all. The proportion offered either a midwife-led unit or birth centre rose from 35% in 2013 to 42% last year. The percentage offered a home birth remained unchanged, though, at 38%.

The results were based on detailed answers given by 18,426 women who gave birth at 130 hospital trusts in February 2017. They showed that four trusts were doing “much better than expected” in their maternity care. They were the trusts in East Cheshire, North Cumbria, Northampton, and Shrewsbury and Telford.

The CQC rated five trusts as “worse than expected”. They were London North West, Milton Keynes, Croydon, University College London Hospitals and Birmingham Women’s and Children’s trust.

But the three lowest-performing trusts, according to respondents, deemed “much worse than expected” by the CQC, were the Rotherham and Sandwell & West Birmingham trusts, as well as Barts Health in London. Barts disputed the results, though. It got scores of at least seven out of ten from 37 of its 51 responses, it stressed.

NHS England, which has made improving maternity care a key priority, welcomed the “marked improvements in women’s experiences of maternity services across safety, personalisation and choice with the vast majority of women reporting that they were always treated with respect and received appropriate advice and support when needed”.

• This article was amended on 1 February 2018 to clarify the context of a quote.

