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NICE issues draft guideline for safe midwifery staffing in maternity settings.

NICE has issued its second draft guideline for safe staffing in the NHS which provides advice on how to make the right decisions about safe midwife staffing levels for women and their babies, wherever they choose to receive care.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “The care that a woman receives, throughout her pregnancy and after she has given birth has a huge impact on her physical and emotional wellbeing, as well as the health of her baby. The Department of Health and NHS England have asked NICE to produce evidence-based guidelines advising the NHS on how to ensure levels of midwife staffing is safe in all maternity settings, be it at home, in the community or in hospital.”

The new draft recommendations set out:

• responsibilities of hospital managers and actions organisations should consider as part of their midwife staff planning,
• the ongoing process that registered midwives should use to determine whether there are sufficient staff to provide for the needs of women and babies,
• and the red flags that warn when immediate action is required.

The draft guideline calls for hospital boards and senior management to plan for all midwife care to be delivered by registered midwives and includes step-by-step guidance on determining the number of midwives required and how to be flexible to unplanned variations.

The draft guideline also proposes that, as a minimum, the number and skill mix of midwives needed should be determined by the midwife in charge at the start of every shift or service, but more frequently in maternity services where needs change quickly (e.g. birthing units). Local factors such as the individual needs of each woman and baby and the availability of other staff or departments should also be considered.

To ensure that a woman has a safe experience of giving birth, the draft guideline stresses that every woman should have at least 1 registered midwife present during established labour1.

Maternity services often experience fluctuating demand. The draft guideline also calls for appropriate escalation plans to be put in place, as a contingency, to guide responses to unplanned changes in the number of midwives available. Proposed responses include delegating activities to other staff or using temporary staff. Contingency plans which affect the provision of maternity services such as cancelling appointments or clinic closures should only be implemented as a last resort.

Hospital boards are accountable for the final staffing decisions but the draft guideline includes recommendations on how management should best work alongside senior midwives when making staffing decisions. It includes a draft recommendation to ensure establishments2 are developed in advance by a registered midwife specifically trained to do this, or other suitable authorised people.

Professor Gillian Leng added: “We are now actively seeking feedback from midwives, hospital trusts, doctors, nurses and other healthcare professionals, as well as members of the public, to ensure the views of all relevant stakeholders are reflected in the final guideline.”

The draft version of this guideline has been published for consultation. NICE encourages comments from stakeholders with an interest in this guideline. Organisations can register as a stakeholder on the NICE website and have until Thursday 13 November 2014 to submit their comments. Individuals are ideally advised to pass comments through a registered stakeholder organisation that most closely represents them but are also welcome to submit comments directly via the NICE website.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Explanation of terms

1. Established labour is when there are regular and painful contractions, and there is progressive cervical dilatation from 4cm.
2. The number of registered midwives funded to work in an organisation providing maternity care. This includes all midwives in post, as well as unfilled vacancies or vacancies being covered by temporary staff.
3. The draft guidance is available at /Guidance/InDevelopment/GID-SafeMidwiferyStaffingForMaternitySettings.

About the guidance

1. The final guideline is expected to be published in February 2015. 

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.