The association between midwifery staffing levels and the experiences of mothers on postnatal wards: cross sectional analysis of routine data

Abstract

BackgroundWomen have consistently reported lower satisfaction with postnatal care compared with antenatal and labour care. The aim of this research was to examine whether women’s experience of inpatient postnatal care in England is associated with variation in midwifery staffing levels.MethodsAnalysis of data from the National Maternity Survey in 2018 including 17,611 women from 129 organisations. This was linked to hospital midwifery staffing numbers from the National Health Service (NHS) Workforce Statistics and the number of births from Hospital Episode Statistics. A two-level logistic regression model was created to examine the association of midwifery staffing levels and experiences in post-natal care.ResultsThe median full time equivalent midwives per 100 births was 3.55 (interquartile range 3.26 to 3.78). Higher staffing levels were associated with less likelihood of women reporting delay in discharge (adjusted odds ratio [aOR] 0.849, 95% CI 0.753 to 0.959, p=0.008), increased chances of women reporting that staff always helped in a reasonable time aOR1.200 (95% CI 1.052, 1.369, p=0.007) and that they always had the information or explanations they needed aOR 1.150 (95% CI 1.040, 1.271, p=0.006). Women were more likely to report being treated with kindness and understanding with higher staffing, but the difference was small and not statistically significant aOR 1.059 (0.949, 1.181, p=0.306).ConclusionsNegative experiences for women on postnatal wards were more likely to occur in trusts with fewer midwives. Low staffing could be contributing to discharge delays and lack of support and information, which may in turn have implications for longer term outcomes for maternal and infant wellbeing.ExplanationWhile we recognise that not all gestational parents identify as women; this term was chosen as it has been used in the data source which was accessed for this study and represents most people having maternities.Statement of significance (problem)Women report negative experiences of postnatal care compared with antenatal care and birth. There is a recognised shortage of midwives in maternity services, and this may be impacting on the quality of postnatal care.What is already known?There is evidence that midwifery staffing levels are associated with birth outcomes but little empirical evidence on the impact of midwifery staffing levels in postnatal careWhat this paper adds?This analysis of survey data supports previous findings that increased midwifery staffing is associated with benefits. This is the first study to examine the effects of staffing on women’s experience of postnatal care.

Exploring the relationship between women’s experience of postnatal care and reported staffing measures: an observational study

“…Our study using the National Maternity Survey data in the preceding year also found a relationship between Trust FTE midwives and better postnatal experience[22]. Although we expected CHPPD to better reflect the staffing experienced by women, CHPPD for registered staff may still be a crude measure of workload as patient acuity and turnover are not factored in.…”

“…Additional analyses of midwifery staffing across services were undertaken using staffing measured at an organisational (i.e. Trust) level as in our earlier study [22]. This newly obtained 2019 dataset was used to confirm or counter our previous findings at a Trust level.…”

“…The null model was a two-level random intercept model with no predictors to explore the extent of between-trust variation in the outcomes. Covariates of mothers' age band, parity, type of birth and midwifery staffing measures were included in the main model as these characteristics have been shown to contribute to the greatest amount of variability in clinical outcomes and patient experience measures [22,33]. Additional covariates of survey response rate, ethnic case mix of Trust, number of births in each Trust and obstetric/gynaecological medical staffing were added to the main model and were retained only if the model fit improved.…”

“…One cross sectional study found that higher registered midwife workforce is associated with a better postnatal care experience, as measured by the National Maternity Survey in England [22]. This study measured staffing at an organisational level across the whole maternity service.…”

“We Beat them to Help them Push”: Exploring Midwives’ Perspectives on Obstetric Violence in Ghana

“…With a midwife-patient ratio of 2.7 per 1000 patients in Ghana [49], midwives work under undue stress and this increases their aggression which is then transferred to the laboring woman. This requires an intense effort from the Ghanaian government to increase the midwifery workforce to reduce the pressure on midwives as higher staffing has been demonstrated to be highly associated with timely care, supportive care, and kind treatment of women during delivery [50]. Participants also blame women's poor maternal efforts as another major cause of obstetric violence.…”