title: Weekend working: a retrospective cohort study of maternal and neonatal outcomes in a large NHS delivery unit.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, UK. Electronic address: cema2@cam.ac.uk.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Aiken
authors.affiliation: Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
authors.forename: Abigail R
authors.initials: AR
authors.lastname: Aiken
authors.affiliation: McCombs School of Business, University of Texas at Austin, TX 78712, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Scott
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, UK.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Brockelsby
authors.affiliation: Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
authors.forename: James
authors.initials: J
authors.lastname: Trussell
mesh_terms: D000328:Adult; D003253:Consultants; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics / Q000458:organization & administration*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult
keywords: Consultants; Delivery outcomes; Health policy; Maternity services; Weekend working