Maternal and neonatal outcomes are not affected by whether or not a senior obstetrician (a consultant) is scheduled to be present on labour wards, finds a study led by the RCOG and the London School of Hygiene & Tropical Medicine, published in PLOS Medicine.
The study, using data from over 87,000 births[i] across 19 UK obstetric units, examined the relationship between consultant presence and three neonatal outcomes: an Apgar score of less than 7 at 5 minutes after birth (a low Apgar score is strongly associated with risk of neonatal and infant death), an umbilical cord pH less than 7 (an indication of oxygen deprivation during delivery), and admission to neonatal care. The study also examined the effect of scheduled consultant presence on operative deliveries and severe maternal outcomes.
Results found that 55.8% of births occurred outside of core working hours of consultants and there was no evidence that the outcomes for mothers or their babies were different. The study did find that women who delivered ‘out-of-hours’ were slightly less likely to have an emergency caesarean section (12.7% compared to 13.4%) or have a forceps or ventouse birth (15.6% compared to 17.0%).
The authors note that obstetric teams may have tried to ensure that women at a higher risk of complications are delivered ‘in-hours’ and therefore the current organisation of maternity care allows for good planning and risk management. This is the first study to analyse data using hospital rotas where consultants are scheduled to be present on the labour wards, however the authors were not able to account for consultant presence at an individual patient level, nor for midwifery and paediatric presence, or the stage of the junior doctors’ training (ST1 – ST7).
Dr David Richmond, co-author of the study and President of the Royal College of Obstetricians and Gynaecologists, said:
“This study provides us with reassurance that maternity services in the UK are safe. However, our recent report on patterns of care in English NHS Trusts identified significant variation across maternity units in the types of intervention given and the outcomes women experienced. This could suggest that not all women are getting the best possible care across the country. We are calling on maternity services to examine their own practice in context and identify priority areas for reducing variation and further improving the safety and quality of care provided to women and their babies.
“There remains a need for an increased consultant presence on labour wards, not only to help with the increasing complexity of care that women need, but also to ensure that our trainees are provided with the opportunities for training and education by senior staff at all times of the day and night.
“Appropriate levels of staffing at all times are crucial. However, implementing increased consultant presence when we are dealing with 15-20% rota gaps across the service for some middle grade posts, presents significant challenges for our specialty. Working out these sustainable staffing models and the service implications are issues that the College is addressing through our Working Party Group Safer Women’s Health Care, due to report later this year.”
Professor Jan van der Meulen, co-author of the study and Professor of Clinical Epidemiology at the London School of Hygiene & Tropical Medicine, said:
“This is the first large, multicentre study to provide a detailed analysis of obstetric practice and outcome according to the presence of obstetric consultants on the labour ward. Although there was no indication that outcomes for mothers and babies were significantly different, we found small variations in practice according to the time of birth.
“Building on these results, there is a need for more robust national evidence on the quality of care at all times of the week by maternity units employing different models of labour ward staffing. We are delighted that a National Maternity and Perinatal Audit has been set up that will assess on an ongoing basis the quality of care provided to all women giving birth in NHS maternity units in England, Scotland and Wales.”
Notes to editors:
Knight HE et al. (2016) Birth “Out-of-Hours”: An Evaluation of Obstetric Practice and Outcome According to the Presence of Senior Obstetricians on the Labour Ward. PLoS Med 13(4): e1002000. doi:10.1371/journal.pmed.1002000.
Read the report on Patterns of Maternity Care in English NHS Trusts 2013/14, published by the RCOG and LSHTM on 23 March 2016.
The RCOG, in partnership with the London School of Hygiene & Tropical Medicine, Royal College of Midwives and Royal College of Paediatrics and Child Health, will lead a new National Maternity and Perinatal Audit, which will evaluate the quality of care received by women and newborns cared for by hospital services in England, Wales and Scotland.
For further information, please contact the RCOG Media and PR team on 020 7772 6300 or email firstname.lastname@example.org.