Women should have own midwife while giving birth

Women should have own midwife while giving birth

In its second guideline* for safe staffing in the NHS, NICE gives advice on how to make the right decisions about midwifery staffing levels for women and their babies, wherever they choose to give birth.

The new recommendations set out responsibilities of senior managers and actions organisations should consider as part of their midwifery staff planning, as well as how registered midwives on a shift should monitor whether there are sufficient staff to provide safe care for the needs of women and babies.

It calls for commissioners, hospital boards and senior management to focus on the needs of each woman and baby and ensure there are enough midwives employed to provide safe care, regardless of the time of day or the day of the week.

The guideline provides step-by-step guidance for organisations to work out the number of midwives required, including making sure that local records are used to help predict requirements and any potential variations in demand. Hospital boards are accountable for the final staffing decisions but the guideline recommends how management should best work alongside senior midwives when making staffing decisions.

The committee recognised that giving birth can be associated with serious safety issues and in order to ensure that a woman has a safe experience of giving birth, the guideline recommends that women in established labour should receive supportive one-to-one care.

Miles Scott, chief executive at St George’s University Hospitals and chair of the committee that developed the guideline, said: “Maternity services must focus on planning midwife care adequately in advance to ensure women, babies and their families all receive the midwifery care they need. This new guideline sets out a systematic process to follow to decide how many midwives need to be employed whilst allowing for flexibility to respond to fluctuating demand.”

The guideline includes recommendations for appropriate escalation plans as a safety net to respond to unexpected changes in demand. These include sourcing extra staff, redistributing midwives’ workload to other competent staff or rescheduling non-urgent work. However, it stresses that any action taken must not be at a detriment to other areas and that service closures should only be considered as a last resort.

For senior midwives, the guideline recommends regularly monitoring positive and negative events which can provide information on whether staffing is adequate. This can be done using data already being routinely collected such as appointments being booked on time, mothers given help with breastfeeding or staff reported events like missed breaks and overtime.

The guidance also highlights warning signs for patients and hospital staff to identify when there may be too few midwives on hand. These ‘midwifery red flag events’ can include if a woman waits more than an hour for stitches or to be washed after giving birth, or is not provided with the medicines she needs following admission. Red flag events should be notified to the midwife in charge to determine whether any action is needed. 

Cathy Warwick, chief executive officer, Royal College of Midwives, said that the guidance “should help to ensure that maternity services have safe staffing levels that are monitored on a regular basis and are adjusted according to local need”. 

“The report highlights the vital importance of ensuring adequate staffing in the antenatal and postnatal periods, as well as in labour,” she said.

* Safe midwifery staffing for maternity settings. NICE NG4, February 2015

By Ingrid Torjesen,

On Medica, Friday 27th Febraury 2015

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