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3. Staffing
Anaesthetists are involved in the care of over 60% of pregnant women. The Audit Commission found
a wide variability of anaesthetic staffing on labour wards [10] and a recent survey confirms this [6].
Previous recommendations concerning anaesthetic staffing were based on delivery rates. Busy units
were defined somewhat arbitrarily as those with > 5000 deliveries per year, an epidural rate > 35%
and a caesarean section rate > 25%, tertiary referral centres and/or centres with a high proportion of
high-risk cases. It was proposed that there should one consultant session per 500 deliveries with at
least 10 sessions for units with over 3000 deliveries [2]. However, there are several problems with the
use of such definitions [11]. The use of crude delivery rates:
• Does not take into account the huge variation in casemix that exists between units
• Does not take into account the impact of changing obstetric demographics (increased maternal
co-morbidities such as obesity, increased maternal age, increased assisted conception,
increasing immigrant population)
• Does not take account of the impact of the changes to training in anaesthesia (in particular the
effect of the European Working Time Regulations on training, associated paperwork and reduced
trainee numbers)
• Does not reflect the increased demand for the delivery of additional anaesthetic services such as
anaesthetic clinics, maternity high dependency units (HDUs) and support for interventional
radiology, etc
• Does not take into account changes in obstetric practice, such as increasing rates of caesarean
section, trial of instrumental delivery, cervical cerclage and repair of complex tears, all of which
increase theatre workload
The calculation of consultant sessions will need to take into account the volume of clinical work, the
contribution by consultants towards administration and other non-clinical activities, and the numbers
and experience of trainees. It is essential that the contribution made by non-consultant career-grade
anaesthetists is included.
It is the unanimous opinion of this Working Party that a move towards obstetric anaesthetic services’
being fully consultant delivered is both desirable and inevitable. Obstetricians have already set this
as an objective and are in the process of working towards it [12]. Ultimately, obstetric consultant
sessions devoted to emergency and elective obstetric activities should be matched by anaesthetic
consultant sessions.
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