Midwifery staffing: Variation and mismatch in demand and capacity

Pressure on maternity services arising out of variation in number of births has always existed. Of singular importance during peak demand is the capability of maternity units to maintain safe outcomes. Additional to variation in birth numbers, heightened patient expectations, social issues and increased prevalence of medical comorbidities have increased functional demand on maternity units, at a time of more restricted health expenditure. Intuitively, it seems logical to suppose that gaps in provision experienced in practice could have an accumulative effect on patient satisfaction, clinical outcomes, and perhaps even midwives' health and morale. This review presents data on variation in birth rates over seven decades, across the seasons, during the week and throughout the day. Recent functional demands on maternity services are reviewed alongside changes in staffing that influence capacity. The need for further research into possible links between demand, staffing and outcomes is explained.