Abstract

The Healthcare Commission Maternity Services Review highlights the importance of well-resourced maternity units operating with coordinated multidisciplinary teams. The RCM (Royal College of Midwives) annual survey of UK heads of midwifery service determined that almost 75% of maternity units were experiencing staffing shortages, with current staffing being below recommended levels to provide one-to-one care. It is known that inadequate staffing levels have an adverse impact on the quality of care and risk management. In this study the authors investigated the effect work load has on labouring women.

Retrospective data were collected for all labourers on a busy labour ward over 2-month period. The length of second stage of labour was recorded for all labouring women together with the availability of qualified midwives and the labourer/midwife ratio was calculated for each case.

793 women delivered in our unit over the study period. The length of second stage was significantly longer in those women who were in second stage of labour during shift change over. Mean 220 min (SD=148.97) from full dilatation to delivery compared to mean 64 min (SD=74.46) for women who did not labour over shift change (p<0.0001, 95% CI 134.66 to 176.74). The length of second stage was not significantly affected by the midwife/labourer ratio or by the time of day when second stage occurred.

The authors conclude that shift changeover has a significant effect on the length of second stage of labour and that shift working pattern may have a detrimental effect on patients.