Related to:Contraception, General Mortality, Teenage Conceptions, Breastfeeding, Wellbeing

 Key Facts:

  • There were 1,854 live births in Bath and North East Somerset in 2013. In line with national trends, the number of live births in B&NES per year has been increasing overall since 2008.
  • The fertility rate (number of live births per 1,000 women aged 15-44) in B&NES in 2013 was 51, lower than the South West (60.7), and England (62.4). Fertility rates have remained fairly stable over time.

  • In 2013, the greatest proportion of live births were to mothers aged 30-34 years, 32.5% in B&NES, 30.5% in the South West, and 30.6% in England.

  • In 2013 in B&NES 25.9% of live births were to mothers aged 35+ higher than the proportions in the South West (20.0%), and England (20.3%).

  • In B&NES there are higher numbers of mothers giving birth at home compared with regionally and nationally

  • There has been an increase in complex and high risk pregnancies, higher numbers of older women, women with a high Body Mass Index (BMI) and women with pre-existing medical conditions 
  • Rates of premature and still births are lower in B&NES than nationally

What does the data say?

ONS projected there to be 1800 live births to B&NES mothers in 2013, there were in fact 1,854 live births in 2013. 1

In line with national trends, despite a reduction in the the number of live births in B&NES in 2013 compared to 2012, the number per year has been increasing overall since 2008.

Figure 1: Numbers of live births in B&NES (2008-2013)  2

Fertility rates

The fertility rate (number of live births per 1,000 women aged 15-44) in B&NES in 2013 was 51 per 1,000 women aged 15-44, lower than the South West (60.7 per 1,000 women aged 15-44), and England (62.4 per 1,000 women aged 15-44). 3

Despite the increasing number of live births, the fertility rate has remained fairly stable over time because there has been a rise in the number of women aged 15-44. The fertility rate in B&NES has remined lower than the South West and England.

Figure 2: The fertility rate (number of live births per 1,000 women aged 15-44) in B&NES, South West and England (2009-2013)  4

Age of mothers at birth

In 2013, the greatest proportion of live births were to mothers aged 30-34 years, 32.5% in B&NES (603 live births), 30.5% in the South West (17,909 live births), and 30.6% in England (203,193 live births). This was closely followed by live births to mothers aged 25-29 years, 25.0% in B&NES (463 live births), 27.9% in the South West (16,407 live births), and 28.1% in England (186,582 live births). 5

Figure 3: Live births by age of Mothers at birth in B&NES, South West, and England (2013) 6

Young mothers - In 2013 in B&NES there were 14 live births where the mother was under 18 years old, overall the number of live births to under 18 year old has been deceasing slightly in B&NES, from 19 in 2009 and 16 in 2010. For information about young mothers aged 15-17 years see - Teenage Conceptions 7

The birth rate of under 18 year olds (number of live births per 1,000 women and girls under 18 years) in B&NES in 2013 was 4.7, lower than the South West (7.1), and England (7.8). 8

Since 2009, the birth rate of under 18 year olds (number of live births per 1,000 women and girls under 18 years) has steadily declined over time. In 2009 it was 6.1 in B&NES, 10.1 in the South West and 11.8 in England. 9

Older mothers - In 2013 in B&NES 25.9% (481 live births) of live births were to mothers aged 35+ higher than the proportions in the South West (20.0%), and England (20.3%). 10 The proportion of live births to mothers aged 35+ has remained fairly stable in B&NES since 2009. 11

As women get older, both mothers and babies face an increased risk of pregnancy-related complications and health problems. These are due to changes in the reproductive system and the increased likelihood of general health problems that comes with age

Problems include: 12

  • Greater difficulty in initially conceiving a child – more need for assisted conception
  • Increased risk of complications for both mother and infant during pregnancy and delivery (although the actual size of the risk may be small)
  • Greater risk of general maternal health problems, such as high blood pressure, which can contribute to complications
  • Higher risk of miscarriage in women above the age of 35
  • Higher risk of having twins or triplets, which is itself associated with higher risk of complications 
  • Increased chance of having a baby with a congenital abnormality, such as Down‘s syndrome 
  • Increased risk of pre-eclampsia
  • Increased risk of complications during delivery, such as prolonged labour, need for assisted delivery or Caesarean section, or stillbirth

Complex and high risk pregnancies

There has also been an increase in complex and high risk pregnancies, higher numbers of older women, women with a high Body Mass Index (BMI) and women with pre-existing medical conditions which means that there are fewer women experiencing a ‘normal’ pregnancy 13

All these factors combine to put pressure on maternity services and staff tell us that some units have had to close their doors to women in labour. Staff ratios are often 1:45 (should be 1:28) and perhaps due to this staff turnover is up, as are the number of staff on long term sickness. This was highlighted in a recent (Dec 2012) CDC report on the Royal United Hospitals Maternity Wing which stated that “there were not enough qualified, skilled and experienced staff to safely meet patients’ needs at all times. Concern was also raised about the cleanliness of the ward.

Premature births

In B&NES 5.4% of births were premature* (before 37 weeks), this represents approximately 90 births per year14 (8% nationally)

* please note that the births data is from Wiltshire and so will not represent babies that were born in Bristol. It covers over ¾ of births to B&NES mothers. The same will apply to the smoking in pregnancy data

There are a group of young women and women from more complex families who are at risk of a range of negative factors

Smoking, excessive alcohol consumption, substance misuse (all higher in more deprived groups and complex families) are contributing factors to premature births15

Stress and anxiety are also contributing factors to premature births – we would expect this to be fairly high in families experiencing domestic violence and those suffering from mental health issues16

Low birth weights

In 2013 in B&NES, 5.6% of live births resulted in a baby that was under 2.5kg (this is considered below the normal weight range), this proportion was slightly lower than in the South West (5.9%), and England (7%). 17

Elective caesareans

There is a higher elective caesarean rate in B&NES than other areas. 18

Home births

In B&NES there are higher numbers of mothers giving birth at home compared with regionally and nationally (5% in 2011, under 4% regionally and 2.5% nationally in 2010)19

A high percentage (91%) of women feel that they have reasonable access to a home birth and most have access to a midwife-led birth centre and an obstetric unit in a hospital

Stillbirths

Year on year there are wide variations in the B&NES stillbirth rate, from 0.6 to 7.9 per 1000 births or between 1 and 13 actual births. This level of variation is expected due to the very small numbers of stillbirths. The average rate is 4.5 per 1,000 births which is lower than the national rate of approximately 5.1 per 1,000 births20

Abortions

82.4% of abortions carried out in NHS Bath and North East Somerset were within 9 weeks of conception in 2013. This was higher than the regional average percentage (78.6%) and the England percentage (79.5%). Nationally the percentage of abortions within 9 weeks varied from 56.2% in NHS Barnsley to 87.6% in NHS North and West Reading for 2013 21

The percentage of repeat abortions in under 25s was 19.9% in NHS B&NES for 2013. This was lower than the regional average percentage (22.9%) and the England percentage (26.9%). It was also the second lowest percentage in the region. For 25-34 year old residents, 41.4% had a repeat abortion during 2013. This was similar to the regional average (41.9%). For over 35s, the rate was 37.7% locally, compared to 41.4% regionally. 22

The percentage of abortions carried out by medical procedure in NHS B&NES was 36% for 2013. This was lower than both regional (41.5%) and national (48.2%) rates and was the third lowest in the region for 2013.

Unicef’s 2013 low birth weight rates in rich countries comparative overview 23

In Unicef’s 2013 low birth rates in rich countries comparative overview, Unicef compares 29 of the world’s most advanced economies.

According to the United States Centers for Disease Control and Prevention, “The birth weight of an infant is the single most important determinant of its chances of survival and healthy growth.” It is also a guide to the general health, and health behaviours, of pregnant women and mothers, both of which are important to every other dimension of child well-being. Low birth weight is also known to be associated with increased risk across a range of health problems in childhood and on into adult life.

Unicef’s report states that in the UK on average 7.1% of babies are born with low birth weights below 2,500 grams. This is in the bottom third of the league table of the 29 countries.  Five European countries – Estonia, Finland, Iceland, Ireland and Sweden –have succeeded in reducing the incidence of low birth weight below 5%. Only in Greece, Hungary, Portugal and the United States does the low birth weight rate exceed 8%.

It is important to note that one of the limitations of these league tables is that internationally comparable data on children’s lives is not sufficiently timely. Between the collection of data in a wide variety of different settings and their publication in quality-controlled, internationally comparable form, the time-lag is typically two to three years. This means that most of the statistics on child well-being used in this report, though based on the latest available data, apply to the period 2009–2010.