Midwife-led assessment of non-catastrophic obstetric emergencies; work activity and patient attitudes

A high proportion of pregnant women attending for urgent assessment do not need emergency care and they have lower clinical priority compared with women who have serious complications in labour. We are aware that this results in a high number of complaints about waiting times. We set up a midwife-led service founded on the introduction of integrated care pathways for the six commonest conditions, based on national recommendations. A review of the case notes of 100 consecutive women who attended the maternity assessment centre was undertaken, of which 99 were suitable for analysis. On average, eight new patients were seen each day. The study found that 60% of the sample were cared for by a midwife alone and just one in three underwent direct medical assessment. The proportion cared for by midwives alone varied widely according to the presenting condition; more than 90% of those with reduced fetal movement but just one in three of those attending with antepartum haemorrhage. On average, women waited for a total of 80 min (range 35-290 min). More than 80% were in the unit for less than 120 min. On average, the wait times appeared to be longer for those women presenting with hypertension, probably because of the greater need for laboratory testing. Of a subset of 20 women surveyed by telephone questionnaire, only one (5%) was surprised to have been seen by a midwife; 17 (85%) said the counselling was excellent or good; 18 (90%) said they would be content to see a midwife for any future visit but two women said they would prefer to see a doctor at a future visit.