Resident consultant presence in labour ward after midnight - a retrospective cohort study of 5318 deliveries.
Abstract Introduction: The Royal College of Obstetricians and Gynaecologists, in their document "The future role of the consultant," recommended that there should be a resident obstetric consultant present in the labour ward for 24 h in large UK hospitals. There is little work that validates this recommendation. The period from midnight to 08:00 h is the most disruptive to work-life balance.


OBJECTIVE
This retrospective study evaluates obstetric outcomes from midnight until 08:00 h in relation to the consultant being a resident or on-call from home over a 3-year period.


METHODS
The Hull Royal Infirmary is a obstetric unit delivering more than 5000 babies annually. There are nine consultant obstetricians and three associate specialists who provide cover; nine always go home when on-call and return to the hospital if needed after midnight and three are resident in the hospital for personal reasons. There is a registrar and house officer resident at all times. All birth data are contemporaneously recorded on a database.


RESULTS
A total of 5318 deliveries were studied over a 3-year period (resident consultant, n=1226; consultant on-call from home, n=4092). There were significantly fewer forceps deliveries when the consultant was on-call from home (3.3% vs. 5.1%, odds ratio 0.65, 95% confidence interval 0.48-0.88), but there was no difference in any other delivery outcome (caesarean 14.5% vs. 13.9%). There were no differences between the rates of stillbirth (0.4% vs. 0.4%) and babies born with low Apgar scores (1.4% vs. 1.3%) when the consultant was on-call from home.


CONCLUSIONS
There is an increased incidence of forceps delivery when the consultant is resident, but there is no difference in any other obstetric parameter. The recommendation for consultant presence in the labour ward has not been validated by this study.
Jawad
J
Freites
Chetan
C
Ruprai
Haran
H
Paul
Stephen William
SW
Lindow
D015331:Cohort Studies; D003253:Consultants; D036861:Delivery, Obstetric; D006801:Humans; D007743:Labor, Obstetric; D012189:Retrospective Studies