Prospective semistructured observational study to identify risk attributable to staff deployment, training, and updating opportunities for midwives

Abstract

Objective To identify potential risk or mishap in the system of intrapartum care, relating to the deployment of midwives. Design Prospective semistructured observational study. Setting Labour wards of seven maternity units in the north west of England. Participants All midwives working on the labour ward during the observation period in 2000. Main outcome measure "Latent failures" within the system relating to midwifery staffing levels, deployment, and training or updating opportunities. Results Despite the exemplary dedication of midwives, potential risk of mishap due to their deployment occurred within the system of care. A shortfall of midwives existed in all seven maternity units and was most acute in the largest units. Six units relied on bank midwives to maintain minimum staffing levels. High risk practices (oxytocin administration and epidural blockades) continued during midwifery shortfalls in all units. Some adverse events and "near misses" were attributable to midwifery shortages in all units, and near misses remained unreported in all units. Uptake of opportunities for training or updating in interpretation of cardiotocographs and obstetric emergency management remained low owing to midwifery shortages in all units. A poor skill mix of midwives occurred at times in all units. In six units midwives spent time away from clinical areas performing clerical duties. In three units team midwifery systems were reported to erode labour ward skills and confidence. Conclusion Midwives are fundamental components in the system of intrapartum care, and the system cannot operate safely and effectively when the number of midwives is inadequate, midwives are poorly deployed, and they are unable to engage in opportunities for training and updating.

The Implications of Shortages of Health Professionals for Maternal Health in Sub-Saharan Africa

“…42 A UK study reported that midwifery shortages and poor deployment led to adverse events such as personal injury and frequent nearmisses, such as delays in carrying out emergency caesarean sections, which had fortunately not resulted in injury to the mother or infant. 43 However, little published research from subSaharan Africa exists on the effects of staff shortages on the quality of care, particularly for maternal health. Currently, safe motherhood initiatives are centred on two inter-related strategies: skilled attendants at delivery and emergency obstetric care.…”

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

“…With respect to staffing, it is no coincidence that the available numbers of labor midwives and nurse anesthetists were correlated with improvement, because both provide important lifesaving functions [14][15][16][17]. The worsening staffing ratios for many provider groups in this report are concerning.…”

Labour ward incidents and potential claims – lessons learned from research

“…Background information was also provided from an observational study in the same units the previous year, some of which has been reported. 9 An expert panel applied the Bolam test to identify where the standard of care fell below an acceptable level. The panel included two consultant obstetricians, a consultant neonatologist and neonatal midwife, a consultant midwife and a midwifery risk manager, in addition to the researcher.…”

“…Midwifery staffing levels were often inadequate during these shifts, especially during periods of sickness and holidays, as the unit's staffing levels rarely ever achieved the recommended minimum staffing levels. 9,11 Although errors often occurred during more than one stage of labour, the majority occurred during the first stage (in 31 cases, 84%). In 19 cases (51%), they occurred during the second stage of labour and in 27 cases (73%) they followed delivery.…”