Background Both my babies came into this world ‘out of hours’. On reflection during most of my almost a decade of middle grade training, most of the babies the author delivered were out of hours, unsupervised and with the current ‘rushed through’ training, a 24 h consultant led service is possibly the way ahead.
‘Safer Childbirth’ highlights the need for an increased level of consultant involvement in the care of high risk women on the labour ward and in the training of medical staff.
Objective To assess how busy a consultant Obstetrician is on call, to work towards an urgent need for 60 h cover.
Setting A District General Hospital in Cheshire serving a population of 191 000 with 97 203 women. The maternity unit had 3233 annual deliveries with eight consultants on the rota.
Study Period 12 months to 50 on call days.
Results Telephone consultations from 2100 onwards occurred more than once on 25 occasions. Presence was asked for on the unit 12 times; three times as there was more than one urgent problem and for nine different clinical situations.
Conclusion The organisation of care on labour wards needs urgent review. The unit is now going to implement 60 h cover from 2010 and will be looking to appoint a further two consultant colleagues so that fixed clinical sessions and waiting lists the following day do not suffer. In my opinion, best practice to provide high quality care and adequate supervision for doctors in training, would be to have 24 h consultant presence on our labour wards.
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