Resident consultant obstetrician presence on the labour ward versus other models of consultant cover: a systematic review of intrapartum outcomes

Abstract

BackgroundSeveral key policy documents have advocated 24‐hour consultant obstetrician presence on the labour ward as a means of improving the safety of birth. However, it is unclear what published evidence exists comparing the outcomes of intrapartum care with 24‐hour consultant labour ward presence and other models of consultant cover.ObjectivesTo collate and critically appraise evidence of the effect of continuous resident consultant obstetrician cover on the labour ward on outcomes of intrapartum care compared with other models of consultant cover.Search strategyStudies were included which quantitatively compared intrapartum outcomes for women and babies where continuous resident consultant obstetric cover was provided with other models of consultant cover.Selection criteriaQuantitative studies within healthcare systems with mixed obstetric‐midwifery models of care.Data collection and analysisTwo researchers independently screened titles and full‐text publications, extracted data and assessed the quality of included studies. Meta‐analysis was performed using REVIEW MANAGER 5.3.Main resultsAbout 1508 publications were screened resulting in two papers, three conference abstracts and one letter being included. All were single‐site time‐period comparison studies. The quality of studies overall was poor with significant risk of bias. The only significant finding in meta‐analysis related to instrumental deliveries, which occurred more frequently when there was on‐call consultant cover (unadjusted risk ratio 1.14; 95% CI 1.04–1.24).ConclusionNo reliable evidence of the effects of 24‐hour resident consultant presence on the labour ward on intrapartum outcomes was identified.Tweetable abstractMore robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence.

Hospitals by day, dispensaries by night: Hourly fluctuations of maternal mortality within Mexican health institutions, 2010–2014

“…Recent studies in the UK, specifically tested for whether a 24-hour presence of an obstetrician in the labour ward, resulted in improved outcomes for women and newborn [ 28 , 29 ] Although no significant association was found, the situation in Mexico around this specific matter may not be comparable for a variety of reasons. Firstly, maternal and neonatal mortality rates in Mexico are much higher than in the UK (maternal mortality was estimated to be almost seven times as high and neonatal mortality almost three times as high in 2016)[ 30 ].…”

Skills training for operative vaginal birth

“…Increased consultant presence has been associated with reductions in Caesarean section rates in some studies [35,36] and resident consultant cover has been associated with higher OVB rates [37].…”

24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis

“…It was recognised that this was challenging to implement, and the RCOG made interim recommendations to improve safety and training where 24/7 cover was not in place [ 12 ]. Systematic reviews of UK studies examining the relationship between consultant presence and adverse events however have failed to demonstrate any reduction in adverse outcomes with increasing consultant presence, though included studies were small and quality was low [ 13 , 14 ]. In 2016 and 2017 the UK RCOG changed their recommendations, suggesting that alternatives to 24/7 consultant presence should be explored [ 15 , 16 ].…”