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6. The labour ward team
Maternity care is delivered by teams rather than individuals. Effective teamwork can increase safety;
poor teamwork can have the opposite effect [9]. A report on safety standards in the maternity services
identified the following problems:
• Differing goals of midwives and doctors with regard to the care of women
• Poor leadership and management
• Difficulties with communication between healthcare professionals during emergencies and shift
changes
It is essential that obstetric anaesthetists should establish clear lines of communication with other
professionals such as intensivists, neurologists, cardiologists, haematologists, other physicians,
surgeons, radiologists, outreach nurses, physiotherapists and pharmacists.
Team briefing and a safety checklist should be used routinely to facilitate good communication and
teamworking and reduce adverse incidents [42].
Checklists and team briefing
Pre-operative checklists and team briefing procedures should be used, both for elective and
emergency obstetric operations. Nationally-developed obstetric modifications of the standard format
exist and should be used or adapted for local use. In extreme emergencies, the procedure may be
truncated, but it must be borne in mind that these are the most error-prone situations. Use of the
checklist should be audited.
Anaesthetists and midwives
‘Midwifery-led care’ refers to all cases in which the lead professional for the case is a midwife rather
than an obstetrician. This type of care may be delivered in a variety of units. If regional analgesia is
required, the anaesthetist may be the only medically-qualified person involved with the
labour/delivery.
It is recommended that the following criteria should be met whenever a hospital or maternity unit is
proposing that anaesthetists should work directly with midwives who are acting as lead providers of
obstetric care:
• There should be a consultant-led obstetric service on site
• There must be guidelines in place for the management of regional analgesia that have been
agreed by anaesthetists, midwives and obstetricians. Midwives practising independently but
intending to make use of a regional analgesia service must agree to follow the guidelines of the
unit where they deliver their clients
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