Evaluating labour ward services: the art of the possible


Carole Brown, Research Midwife, St Mary's Maternity Hospital, Milton Road, Portsmouth PO3 6AD


Midwives have contended that midwifery and obstetric workloads could not be measured and that only a 11 ratio of mother to midwife should occur, at least in the labour ward environment This would appear to be true if traditional hospital statisties are used However, this project set out to measure workload and staffing requirements Using clinically based process and outcome criteria, dependency classification enabled daily, weekly and monthly workload and patterns of workload to be studied Contrary to widely held beliefs it was demonstrated that mothers could be classified according to levels of need which form consistent patterns of distribution A mean average of the total time spent on the labour wards by mothers was calculated for each level of need using 11 months' data. This produced a positive correlation with the dependency classification Dependency classification and total time spent on the labour wards provides a mechanism for measuring workloads To enable economic use of resources, a level of dependency for which a 11 ratio of staff mother is considered essential has to be agreed To assist with this decision two surveys designed to collect information concerning the percentage of the mothers' time spent in contact with the nursing/midwifery staff was conducted. The results were remarkably similar and again demonstrated a positive correlation with dependency classification It was recognized that midwifery is a chronically understaffed service and that midwives working within the service felt unable to give the care they considered a woman in labour deserves In response to this a panel of midwives was asked to pass judgement on the criteria used in dependency scoring, with regard to the time needed to fulfil their function as a midwife, involving both the physical and psychological aspects of care. Substituting the actual contact time with the professionally judged time it was possible to calculate the optimum hours required for direct care of mothers Activity sampling provided information on how staff spent their time This allowed the study of working patterns for more effective and efficient use of the available staff time Though mechanical in its approach, redeployment of work can be achieved With the optimum reallocation of activities, staffing requirements to cover the labour wards and indicators of an appropriate staff mix were calculated