A quarter of women in England are left alone during labour and birth at a time that worries them, according to an official survey.
The finding comes from a poll of 23,000 women by the Care Quality Commission, which is carried out every three years.
While care improved on many ante-natal and post-natal measures, the regulator said it was concerned about what was happening in the delivery room.
Midwife leaders said the problems were directly linked to a shortage of staff.
There are currently over 21,000 midwives in the NHS in England - a rise of 1,200 in two years.
But the Royal College of Midwives believes there is a shortage of 4,800 because the birth rate is at its highest since the early 1970s.
The survey showed a significant number of women were concerned about the care they got during labour and birth.
Some 39% reported raising concerns - although the CQC did not ask whether they were minor or major issues.
Of those that complained, a fifth said they were not taken seriously enough.
Overall, the poll showed:
- 25% of women were left alone during labour or birth - up from 22% in 2010
- 78% of women said they had confidence with the midwives caring for them - up from 73% in 2010
- Three quarters of women said they were always involved in decision about their care - again up from the previous survey
- Nearly nine in 10 said they were spoken to in a way they could understand during both the antenatal and labour/birth periods
About 10,000 women provided detailed comments about their care as well as filling out the survey.
A number of themes arose from their reports, including poor pain management, cleanliness and a sense of bullying over breastfeeding.
Sir Mike Richards, the CQC's chief inspector of hospitals, said he was "encouraged" by the improvements.
But he added: "In too many cases the quality of care delivered is just not good enough.
"Women and their partners are being left alone when it worries them, toilets and wards are described as unclean and some women are not given the pain relief they had expected or planned to use in their birth plan."
Sir Mike said one of the key issues he would be looking at during future inspections would be staffing levels.
Cathy Warwick, of the Royal College of Midwives, said: "The survey shows that the NHS continues to fail too many women. It sets out yet more evidence of the real-life and disheartening effects on women of the shortage of midwives. How many more flashing red lights do we need?"
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