ecause of the competing demands on midwives during spontaneous vaginal birth, particularly in the second stage, the level of staffing, and their roles and responsibilities can affect the safety and quality of care

High quality RCT evidence shows that rates of Obstetric Anal Sphincter injury (OASI) are reduced by 30% when a second midwife is present at births of nulliparous women [Edqvist et al., 2022].

Guidance recommends that the midwife caring for the woman should have four hourly checks from another midwife or doctor when undertaking IA (SBLCB v3); and units are recommended to set up a buddy system to pair up more and less experienced midwives during shifts to provide accessible senior advice with protocol for escalation of any concerns.

Chronic understaffing can also affect attendance at mandatory training which has safety implications.

Observations during field work identified that when a single midwife was present at a spontaneous vaginal birth, tasks had to be prioritised as it was not possible to undertake all procedures required as a single person. Tasks such as documentation often had to be done after the birth, impacting postnatal support and/or the midwife getting off shift on time. 

A review of 115 case-notes from seven NHS sites, found that between 7% and 70% of vaginal births where IA was used during labour had documented evidence of a second midwife at birth.  Forty-eight percent of 174 maternity units reported practicing a buddy system or “fresh ears”.

Listen2Baby recommends:

that a second midwife be present at all spontaneous vaginal births, providing support for at least 15-30 minutes prior to birth in nulliparous women.[Edqvist et al, 2022];
that staffing models facilitate the presence of a senior midwife to provide regular holistic supportive review