Repository logo
 

Weekend working: a retrospective cohort study of maternal and neonatal outcomes in a large NHS delivery unit.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Aiken, Catherine E 
Aiken, Abigail R 
Scott, James G 
Brockelsby, Jeremy C 
Trussell, James 

Abstract

OBJECTIVES: Mandatory weekend working for NHS consultants is currently the subject of intense political debate. The Secretary of State for Health's proposed 7-day contract policy is based on the claim that such working patterns will improve patient outcomes. We evaluate this claim by taking advantage of as-if-at-random presentation of women for non-elective deliveries throughout the week. We examine (i) whether consultants currently perform fewer deliveries during weekends versus weekdays, and (ii) whether adverse outcomes increase during weekends. STUDY DESIGN: We conducted a retrospective cohort study using data on all non-elective deliveries from January 2008 to December 2013 in a large UK obstetrics centre (n=27,466). We used Pearson's chi-squared tests to make direct comparisons of adverse outcome rates during weekdays versus weekends. Outcomes included: estimated maternal blood loss ≥1.5l; severe perineal trauma; delayed neonatal respiration; umbilical arterial pH <7.1; and critical incidents at delivery. RESULTS: Consultants currently perform the same proportion of non-elective deliveries on weekends and weekdays (2.3% versus 2.6%, p=0.25). We found no increase in any adverse maternal or neonatal outcomes during weekends versus weekdays, despite high statistical power to detect such differences. Moreover, adverse outcomes are no higher during periods of the weekend when consultants are not routinely present compared to equivalent periods during weekdays. CONCLUSIONS: Under current working arrangements, women who would benefit from consultant-led delivery are equally likely to receive one on weekends compared to weekdays. Weekend delivery has no effect on maternal or neonatal morbidity. Adopting mandatory 7-day contracts is unlikely to make any difference to either consultant-led delivery during weekends or to patient outcomes.

Description

Keywords

Consultants, Delivery outcomes, Health policy, Maternity services, Weekend working, Adult, Consultants, Delivery, Obstetric, Female, Humans, Infant, Newborn, Obstetrics, Pregnancy, Pregnancy Outcome, Retrospective Studies, United Kingdom, Young Adult

Journal Title

Eur J Obstet Gynecol Reprod Biol

Conference Name

Journal ISSN

0301-2115
1872-7654

Volume Title

199

Publisher

Elsevier BV
Sponsorship
The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (Grant ID: P2CHD047879)