Evaluating labour ward services: the art of the possible

Midwives have contended that midwifery and obstetric workloads could not be measured and that only a 1:1 ratio of mother to midwife should occur, at least in the labour ward environment. This would appear to be true if traditional hospital statistics 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 1:1 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.(ABSTRACT TRUNCATED AT 250 WORDS)