The following is a typical comment about team responses to stress on the labour ward:
“The labour ward was busy that night and [the midwife] was unable to provide one-to-one midwifery care, which, given the history of reduced fetal movements and suspicious CTG trace, she would have done if there had been another midwife available. No formal escalation policy was followed and the midwifery team just tried to ‘cope’.”
In another stressful situation, concerns about a baby had been raised at a midwifery-led birthing unit, requiring transfer to the delivery suite. Instead of transferring the woman out of the midwife-led unit immediately, a midwife from the community was called to help with the transfer to the consultant-led unit, resulting in a delay of over 2 hours.
Individual responses to stress were highly variable. One report highlighted the conflict created when there is a need to speak up during an emergency and a reluctance to acknowledge it because of the possibility of distressing the pregnant woman:
“The general consensus was that all were aware of the bradycardia but the increasing urgency was not escalated to the operator [In this case the obstetrician waiting to perform a caesarean section, whilst the anaesthetic was ongoing]. It was also felt that it was difficult to verbalise the urgency more in front of very distressed parents.”
In this instance, the stress of the situation caused the team to fail to prioritise the need to communicate the urgency of the situation over the need not to cause any upset to the mother.
In another report, a woman with diabetes was undergoing induction of labour because of suspected fetal macrosomia and developed failure to progress in the second stage. A challenging instrumental delivery failed. The registrar responded to this stress in a positive way:
“The surgeon was alert to the slow progress and that potentially the baby may be large. She was aware that the caesarean may be difficult to perform as the fetal head was deep within the pelvis.”
There was early recognition that there was the potential for difficulty, and help was summoned early. A difficult delivery required the assistance of two consultants. The report detailed responses from the whole team, which reflected a positive response to stress.
None of the reports where stress, fatigue or a high workload were identified as contributory causes made systemic recommendations to address these issues.