Factors affecting the delivery of safe care in midwifery units

This report is intended for healthcare organisations, policymakers and the public. It is based on a thematic analysis (a process that looks for common themes) of 92 maternity investigation reports, where the safety incident under investigation included care provided in a midwifery unit.

Midwifery units are staffed by midwives and support staff. Typically, pregnant women who choose to give birth in a midwifery unit have been assessed as having a low chance of complications during labour and birth. Sometimes a pregnant woman or baby may need to be transferred from a midwifery unit to an obstetric unit (a hospital unit where specialist doctors are primarily responsible for their care) to receive additional care and treatment.

The thematic analysis identified 4 main themes and findings, which include issues relating to:

1. Work demands and capacity to respond – the number of tasks needed to be done and whether there are enough (and suitable) staff, and appropriate physical space, to do them.
2. Intermittent auscultation – a method used to assess a baby’s heart rate as an indicator of their wellbeing.
3. How prepared an organisation is for predictable safety-critical scenarios, and the role played by in situ simulation (a training method that involves staff rehearsing scenarios in the workplace).
4. Telephone triage – the assessment a midwife carries out when a pregnant woman telephones because they have gone into labour or have a concern about their pregnancy.