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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 20; 335(7624): 795.
PMCID: PMC2034679

Royal colleges call for more staff on maternity wards

The four royal colleges that represent UK doctors and nurses involved in childbirth are calling for urgent increases in the number of staff to ensure safe levels of care on maternity wards.

In their report Safer Childbirth the royal colleges for obstetricians and gynaecologists, anaesthetists, midwives, and paediatrics and child health list the minimum standards required for safe childbirth. These include one to one midwifery care for women in established labour and the presence of a consultant obstetrician on the ward at least 40 hours a week.

At the moment, says the report, only 27% of maternity units in England and Wales have enough midwives to guarantee one to one care, and “barely half” say they have an obstetrician available 40 hours a week.

The Royal College of Obstetricians and Gynaecologists' own survey also shows that fewer than a third of units claiming to have 40 hours of cover by a consultant obstetrician actually have one present on the labour ward for this length of time.

The college says that the number of obstetricians in the United Kingdom would have to increase from 1600 to 2100—and “ideally” to 2500—to meet all the report's recommendations. The Royal College of Midwives says that 5000 extra midwives would be needed in England alone.

“If the changes suggested in the document are not met we believe that maternity services will be operating at a suboptimal level,” warned the Royal College of Obstetricians and Gynaecologists.

The report's authors recognise that their recommendations have “considerable financial implications.” But they also note the huge costs of errors in obstetrics. The cost of litigation payments tripled between 1997 and 2002 and reached £269m (€390m; $550m) in 2001-2.

The report also recommends that:

  • Obstetricians should conduct ward rounds at least twice a day on Saturdays, Sundays, and bank holidays and do a ward round as late as possible every evening (as well as the commitment for there to be at least 40 hours' cover)
  • An anaesthetist should be available 24 hours a day
  • An appropriately qualified healthcare professional should be present at all births in any setting, and
  • Women should not wait more than half an hour for an epidural.

The report says that all units that handle more than 2500 births a year should ensure the 40 hour obstetrician cover immediately. And all units with more than 6000 births should have 60 hours of coverage.

Also, units with more than 5000 births must have 60 hour cover by the end of this year. Those with 4000 to 5000 births should hit the 60 hour target by the end of 2008 and most other units by the end of 2009.

The health minister Ann Keen said that an advisory group, which includes representatives from the four royal colleges, was already discussing ways to improve safety further. But, she added, “It would be utterly wrong to give the impression of a maternity service with falling or insufficient staff numbers—there are 2084 more midwives and 474 more consultants in obstetrics and gynaecology [than in] 1997.”


Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour is available at

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