Birthrate Plus: using ratios for maternity workforce planning

Abstract

This is the second in a series of three articles exploring the staffing needs in the maternity services. Undertaking Birthrate Plus studies in hundreds of maternity units in the UK revealed a number of issues which affect any assessment of midwifery staffing needs in both hospital and community services. Using a simplistic approach of the annual births in a hospital as the sole basis for assessing staffing needs ignores the movement of women between different health trusts. Many hospitals provide care to women from outside their catchment area and this ‘cross border’ flow significantly affects the numbers of community midwives required. The patterns and policies of intrapartum care have a large impact upon hospital staffing needs, and these patterns vary across different services. Stand alone midwife-led units provide care for women in the community as well as for those who give birth within the unit. If required standards of midwifery care are to be maintained then more focused methods of calculating staffing needs must be used. This article will explore these issues and explain how ratios have been produced and which can be used to assess staffing needs based upon local information.

Delay in the induction of labour process: a retrospective cohort study and computer simulation of maternity unit workload

“…The study aimed to quantify staffing shortfall per 24-hour period and staffing levels were assessed using the Birthrate Plus (BR+) system. 13 BR+ is a nationally endorsed planning tool which allows calculation of the number of midwives required on a labour ward, accounting for both demand and case mix. BR+ calculates the number of midwives required by adding up the total time mothers spend on the labour ward and multiplying each of five categories of mother according to interventions received during labour by a multiplier, allowing for increased midwife support for higher acuity labours.…”

Application of the birthrate plus (BR+) methodology to identify midwifery workforce shortages in China: a retrospective multisite study

“…The fundamental principle of BR + is based on labor being a special period requiring continuous service. The BR + method predicts the required workload and has 2 key components: the classification system of childbearing women and the required hours of midwifery service 8,13 . Using this method, a midwifery manager can calculate the number of midwives needed based on the total number of childbearing women, the proportions of different types of childbearing women, and the service hours required by all types of childbearing women.…”

“…Hence, it is urgently needed to find an appropriate method to evaluate the midwifery shortage in Chinese settings, where midwifery services focus on intrapartum care rather than the wider span of women's health. The Birthrate Plus (BR + ) Methodology (1993) 7 is an estimation tool specifically for the midwifery workforce 8 . It has been recognized as the "gold standard" 9 for midwifery workforce prediction and has been proven to be very effective when applied in the National Health Systems of the United Kingdom 10 .…”

Report on the Midwifery Workforce in the MOH, Saudi Arabia, for 2019

“…For a maternity service that delivers care by midwives, midwife-to-birth ratio should be one midwife for every 29.5 births. 19 From that data it is possible to calculate the required numbers of midwives to meet all those needs in relation to defined standards and models of care and to local workforce planning needs. Currently, midwiferyled continuity of care is not in place in Saudi Arabia.…”