The Millennium Cohort Study (MCS) collected information about pregnancy and delivery retrospectively at 9-10 months after the child's birth. For this and other reasons, midwives and other clinical staff were not involved in the data collection, unlike the 1946, 1958 and 1970 cohort studies which started as birth surveys. This limited the potential for collecting reliable detailed information about topics such as complications in pregnancy and at delivery. Clearly, pregnancy and childbirth have got safer over time. In the 1946 birth cohort, 4.0% of babies died in the first week after birth, 3.3% in the 1958 cohort and 2.4% in the 1970 cohort (Williams, 1997). On the other hand, the MCS covered some issues not included in the earlier, more clinically oriented birth cohort surveys.

Many but not all of the topics in this chapter are monitored through routine data systems in the four countries of the UK. Birth registration and NHS maternity statistics systems collect information about trends in demographic structure and patterns of care at delivery, although the ways in which they do so differ between countries. What these routine systems do not provide, however, is much information about the social factors which lie behind these changes in care and in the population giving birth. In addition, NHS maternity systems are largely based on information about hospital care. They do not contain information about encounters which usually take place in the community, notably women's first NHS consultations about maternity care and their use of other services such as antenatal classes. The NHS records also contain only limited information about births outside hospital. The aim of this chapter is both to analyse the data about pregnancy and mothers’ use of services in their social context, and to relate them to the trends documented elsewhere.

The national service framework for children, young people and maternity, published in 2004, has a social as well as a clinical agenda (DfES and DH, 2004): ‘Women have easy access to supportive, high quality maternity services, designed around their individual needs and those of their babies.’ ‘Standard 11, maternity’ emphasises choice for women in planning their own care and choosing the place to give birth. It also prioritises the needs of marginalised women, particularly those from disadvantaged groups. Fieldwork for the first sweep of the MCS took place before most of these policies were implemented.