Midwifery is about providing high-quality compassionate care and comfort at one of the most important times in a woman's life. However, factors outside an individual midwife's control can have a major impact on his or her ability to deliver this care. One such factor is the issue of safe staffing, around which there has been much debate, and which the National Institute of Health and Care Excellence (NICE) (2014a) has recently taken steps to address with draft guidance on safe staffing in maternity care.
According to the Royal College of Midwives (RCM), despite the numbers of midwives exceeding that of previous years, when considering the number of women requiring maternity care, there is still a shortage of 3200 midwives (Cooper, 2014). There has been a push to provide more individualised midwife-led care and encourage women to make their own decisions about where and how they are most comfortable giving birth, particularly in light of the recently updated intrapartum care guidelines which indicated the safe outcomes of births across different maternity settings for healthy women with straightforward pregnancies (NICE, 2014b). However, higher numbers of midwives are needed across these settings to ensure that no matter where a woman chooses to give birth, she can expect safe and high-quality care (Cooper, 2014; NICE, 2014b).
The importance of safe staffing
Following care failings highlighted by the Francis report (Francis, 2013), NICE developed guidelines for safe nurse staffing for adult inpatients in acute hospitals (NICE, 2014c) and have recently finished consultations on draft guidelines for safe staffing in maternity settings (NICE, 2014a). The Nursing and Midwifery Council (NMC) (2014) points out that appropriate staffing is important to the delivery of safe health and care (NMC, 2014). Importantly, NICE emphasises that the care a woman receives during her pregnancy, labour and after the birth of her baby has a great impact on both her physical and emotional health in the short and long term, as well as on the health and wellbeing of her baby (Ford, 2014; NICE, 2014b).
The draft guidance
The draft guidelines state that in order for a woman to have a safe birth experience, she should have at least one registered midwife present during established labour (RCM, 2014). Furthermore, it is proposed that cases where a midwife cannot provide continuous one-to-one support during established labour should be considered a ‘red flag’ (Ford, 2014). Several red flags have been listed in the draft guidance, all of which would require immediate action by the person in charge and additional red flags may be agreed locally (Ford, 2014). As has been emphasised by the NMC (2014), safe staffing is as much about patient needs and skill mix as it is about numbers. In keeping with this, the draft guidance also states that the number and skill mix of midwives required should be determined by the midwife in charge at the start of each shift or service and that in services where needs change quickly, such as birthing units, this should be considered more frequently (Ford, 2014).
Next steps
The second set of draft guidelines published on 17 October 20114 closed for consultation on 13 November and the final guidelines are expected to be published in February 2015 (NICE, 2014a). Tracey Cooper, consultant midwife and one of the expert advisors for the guidelines, says that although she is unable to comment on the guidelines until they are complete, she can assure midwives that she, along with two other midwifery colleagues and a service user is doing her best to influence the Committee towards ensuring they understand maternity services so that they provide evidence-based and useful guidance to midwives.
Guidance which is useful to midwives will inevitably impact the quality of care women receive, and the health and wellbeing of women and their babies. It is clear that midwifery is a priority on the national agenda—only time will tell whether it is a high enough priority to fill the 3200-midwife shortage which, with ongoing guidelines such as those published this month (NICE, 2014b) and those expected in February (NICE, 2014a), is only becoming increasingly relevant and urgent to address.