Safe staffing in maternity services: A commissioned rapid scoping review for NHS England

The overarching aim of this rapid scoping review was to provide a rapid appraisal of maternity academic papers, policy, literature, and evidence on safe staffing globally, in countries where the registered midwife role exists. The review addressed four questions relating to: (1) the impact of skill mix models on maternal and neonatal outcomes, patient satisfaction, and healthcare costs; (2) the impact of deployment models for healthcare professionals in maternity services; (3) the understanding and implementation of headroom provision and its effects on staffing and care; and (4) whether single-bedroom maternity wards require different staffing requirements and what outcomes support this. There is limited high quality evidence from UK settings on the impact of skill mix models, including midwifery staffing, task shifting, maternity support workers and increased obstetric consultant presence, on maternal and neonatal outcomes, patient satisfaction and healthcare costs. In contrast, high quality evidence consistently shows that midwifery led continuity of care is as effective as other models for low risk women and may offer cost saving benefits for intrapartum care. Further research is required for women who are at higher risk or who have additional health complications. Findings from a pilot study also indicate that midwifery continuity of care combined with access to a specialist obstetric clinic may provide a safe and beneficial option for women at elevated risk of preterm birth, although larger and adequately powered trials are needed to confirm these results. Evidence for the impact of caseload midwifery compared with standard care, and for midwife led compared with physician led care in UK settings, remains limited. However, findings from Australia suggest that caseload midwifery for women at low risk is associated with fewer interventions, higher satisfaction with care, more positive birth experiences and reductions in costs when compared with other models of care. More broadly, midwifery led care in Australia and the UK appears to be cost effective because of lower rates of preterm birth and episiotomy, although the evidence remains limited for women who have pregnancy related risk. In low and middle income countries, midwifery led care reduces neonatal intensive care admissions, lowers episiotomy rates and is associated with higher rates of vaginal birth, although there is no clear evidence of an effect on preterm birth or early exclusive breastfeeding. Headroom within the NHS takes account of all types of leave and should be compared with actual utilisation using retrospective data from the previous two years. There is substantial variation in headroom levels and staff unavailability across NHS Trusts as recorded in e rostering systems, yet there is insufficient evidence to determine how headroom provision affects staffing ratios, workforce planning or the quality of care outcomes. There is also a lack of evidence directly assessing whether single bedroom maternity wards require different staffing levels or how such differences might influence patient outcomes. Most available evidence instead examines single room maternity care as a care model in the United States, Canada and the Netherlands. This evidence indicates that single room maternity care can improve staff skills and experience by reallocating resources to employ more registered nurses, while maintaining comparable intrapartum safety to traditional models of care. Women experience shorter hospital stays, greater satisfaction with care and potential cost savings, particularly for those at low risk. However, some studies suggest that traditional maternity care may offer greater cost savings in certain contexts.

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