A news report today shows a higher perinatal death rate for births occurring in hospitals during the night. The Dutch study, published in BJOG, looked at births in all Dutch maternity units over seven years. Findings show that hospital deliveries in the evenings (1800 – 2359 hours) and at night (0000 – 0759 hours) were associated with increased perinatal mortality and adverse perinatal outcome. In smaller hospitals (<1,000 deliveries), the mortality and adverse outcome rates were higher. Researchers note that in units where senior staff were present, perinatal mortality and adverse perinatal outcomes were lower.
This new research adds to the growing body of evidence which demonstrates clearly how increased consultant presence in the labour ward improves clinical outcomes. The Temple report, published last week, recommends that flexible working by senior staff, characterised by increased consultant presence to support junior doctors, is required to improve safety and quality of care, in response to the challenges imposed by the European Working Time Directive (EWTD). This requirement is especially pertinent in a specialty such as O&G where births occur round-the-clock and emergencies can happen at any time of the day.
Professor Sir Sabaratnam Arulkumaran, President of the Royal College of Obstetricians and Gynaecologists (RCOG) said “Previous national reports1 have shown that the incidence of severe fetal compromise is highest during the time of the night when consultant presence in hospitals is low, so the findings of this new study shouldn’t come as a surprise to us. To help address this, we are developing online training packages with the Department of Health funded e-learning for Healthcare (eLfH) to ensure that doctors and midwives have the appropriate knowledge and skills in fetal surveillance.
“Complicated births are on the increase in the UK each year and this is a result of population and lifestyle trends which we have little control over. What we can control is the workforce, to ensure that we have enough qualified and experienced staff to provide good and safe maternity services, which is why we have been calling for consultant expansion to meet with increasing service demands over the previous few years.”
14 June 2010
Notes
1 Figures from the National Patient Safety Agency (NPSA). See Appendix 2: ‘Evidence for a consultant-based delivery service’ in The Future Role of the Consultant .
Also refer to Appendix 5: ‘A consultant obstetrician-based service’ in Safer Childbirth. Minimum Standards for the Organisation and Delivery of Care in Labour .
BJOG reference: de Graaf J, Ravelli A, Visser G, Hukkelhoven C, Tong W, Bonsel G, Steegers E. Increased adverse perinatal outcome of hospital delivery at night. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02611.x.