England's maternity services

Calls to improve maternity services in England have been made after a report found that one in five maternity wards are 'performing least well'.

The Healthcare Commission's report - the most comprehensive national review - found widespread variations in the quality of care.

"Real concerns" were raised about the standard care of care in London, blamed in part on low staffing levels.

The watchdog assessed all 148 trusts providing a full maternity service in England, looking at the period from when a pregnant woman first accesses care to her final contact with a midwife - usually ten days after a birth.

Concerns were raised about the number of trusts not meeting national guidelines on antenatal mental health checks; thorough foetal anomaly scans; and readmission rates.

An apparent increase in caesarean sections raised fears as the review suggests some trusts are not focussing on interventions to promote vaginal birth.

And not all trusts were able to meet guidelines on the ratio of midwives to pregnant women.

Seeking to reassure patients on the quality of maternity care, Healthcare Commission chief executive Anna Walker said: "Being put in the least well performing category does not mean that a service is unsafe.

"If we believed any unit to be unsafe, we would take immediate action to ensure patients were protected. We would not hesitate.

"The purpose of the review is to encourage improvement and get all trusts performing to the standard of the best. We will repeat the assessment so that trusts have the opportunity to demonstrate improvement."

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