NHS Study Finds More Labor & Delivery Complications on Weekends

Dr. Palmer

Dr. Palmer

MedicalResearch.com Interview with:
Dr William L Palmer
Honorary research fellow
Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London

Medical Research: What is the background for this study?

Dr. Palmer: For the majority of women and their newborns, their care will be safe and result in good outcomes. However, previous research has suggested that outcomes across a range of healthcare areas might be worse at weekends. We therefore undertook to investigate whether there was an association between day of delivery and complications, using a range of different outcomes: perinatal mortality and – for both women and neonate – injury, infection and emergency readmission rates. Our analysis was based on every delivery to public health services in the NHS in England across a two-year period so accounting for some 1.3 million births. To account for possible differences in case-mix and maternal characteristics we controlled for a range of factors including gestational age, delivery type, maternal age, birth-weight, and pre-existing diabetes or hypertension.

Medical Research: What are the main findings?

Dr. Palmer: We found that there were statistically significant complication rates across the days of delivery. In particular, there was evidence of a “weekend effect”, namely higher complications for deliveries on Saturday or Sunday compared to the rest of the week, for four of the seven indicators. For example, perinatal mortality rate was 7.3 per 1000 babies at weekends compared to 6.4 per 1000 over weekdays. Our analysis suggests that there were some 770 perinatal deaths and 470 maternal infections per year above what you would expect if complication rates were consistent with those on a Tuesday, our midweek reference day. We also tried to investigate whether there was a link between consultant staffing levels; while we did not find a consistent association we did find those trusts that complied with recommended staffing levels had lower rates of perineal tears.

Medical Research: What should clinicians and patients take away from your report?

Dr. Palmer: In the first instance, clinicians, along with service managers, should seek to take greater assurance over the quality and outcomes of care at weekends. Women have the right to expect high quality services irrespective of when they deliver and so clinicians and managers should plan to provide a consistent standard of care across the week.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Palmer: While the study has strengths – for example using a range of outcomes – it has limitations which should be noted and could be addressed in future research. Specifically, our analysis was based on administrative data and we did not directly observe the standard of care provided. And we cannot be sure of the effect of unmeasured confounders or, more generally, other out-of-hours periods such as weekday nights on outcomes. Future work could also focus on the effect of midwifery staffing levels, different health systems – this study only covered England – or in other areas of healthcare.


Association between day of delivery and obstetric outcomes: observational study

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5774 (Published 24 November 2015)Cite this as: BMJ 2015;351:h5774