Document Detail

Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant-led labour wards in Scotland.
MedLine Citation:
PMID:  14629319     Owner:  NLM     Status:  MEDLINE    
Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score < 7 at 5 minutes, admission to neonatal unit (NNU) > 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar < 7 at 5 minutes (0.98 [0.83, 1.15]) or admission to NNU for > 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.
J Tucker; G Parry; G Penney; M Page; V Hundley
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Paediatric and perinatal epidemiology     Volume:  17     ISSN:  0269-5022     ISO Abbreviation:  Paediatr Perinat Epidemiol     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-11-21     Completed Date:  2004-02-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8709766     Medline TA:  Paediatr Perinat Epidemiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  369-77     Citation Subset:  IM    
Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Sheffield, UK.
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MeSH Terms
Apgar Score
Bed Occupancy / statistics & numerical data
Delivery Rooms / manpower*
Fetal Monitoring / standards*
Infant, Newborn
Midwifery / manpower,  organization & administration*,  standards
Pregnancy Outcome*
Prospective Studies
Quality of Health Care*
Workload / statistics & numerical data*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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