The Future Role of the Consultant (2005) and Safer Childbirth (2007) recommend levels of medical staffing on labour ward depending on the number of deliveries and complexity. Our unit delivers >8000 women/year and as such should have 168 h168 hours of consultant presence plus three junior doctors at ST 1–7 level or equivalent, with only one of these at ST 1–2 level or equivalent. Although no unit in the country has yet achieved these staffing levels, many units are moving towards implementation. We already achieve the junior staffing levels and introduced fixed night consultant presence, initially two nights per week, in March 2012.
To assess the impact of this service change, we compared operative intervention rates on the nights with a resident consultant to those nights without, and surveyed all levels of junior staff and midwifery shift leaders regarding different aspects of this service change. We are currently assessing the impact (if any) on clinical incidents.
There were no differences in operative intervention rates between the two groups either in terms of caesarean section (15% vs 16%, p = 0.39) or operative vaginal birth (19.5% vs 17%, p = 0.1).
Junior doctors felt that they were more supported, more confident, received improved training and had improved decision making when there was a resident consultant, but did not feel disempowered. Both junior doctors and midwives felt more reassured, felt the labour ward ran more smoothly and felt it was easier to involve consultants in decision making when there was a resident consultant.
The benefits of consultant presence must be viewed beyond operative intervention rates.