The findings are likely to prompt calls for a change in work practice for obstetricians. Currently, obstetricians work a standard working day, with a night-time on-call service, and round-the-clock consultant care.
The Institute of Obstetrics and Gynaecology is currently studying the survey and is expected to recommend 24-hour consultant presence in maternity hospitals to deal with the high number of problem deliveries at night, according to a report in the Irish Medical Times.
The study, overseen by Prof John Higgins at Cork’s Erinville Hospital, found, of 3,105 births, mortality rates among infants born during on-call hours (night-time) was 1.1% compared to 0.5% during the day.
Prof John Bonnar, former chair of the Institute, said this equated to 11 deaths per thousand during on-call hours and five deaths per 1000 during the day. This means of the 3,105 births included in the survey, there were at least 33 deaths outside of normal consultant working hours and 15 daytime deaths.
Prof Bonnar said it would not be possible to introduce round-the-clock consultant cover without a massive increase in consultant numbers. “We all agreed it is something we should be aiming for, but with only around 100 consultant obstetricians in the country, it cannot be done. We have a long way to go before consultants are able to provide cover 24/7, it would probably mean increasing the consultant complement fourfold.”
He said round-the-clock cover had been recommended by the Royal College of Obstetricians and Gynaecologists in London and that the Institute has been looking at the issue. However, round-the-clock cover was likely to apply to larger maternity units with an excess of 4,000 births per annum, Prof Bonnar said.
The Hanly Report, which deals with the reconfiguration of Irish hospitals, recommends a 24-hour, seven days a week on-site presence in maternity wards.
Because of a manpower shortage, it was not always possible to provide round-the-clock cover and consultants had other responsibilities, including clinics, Prof Bonnar said.
He said many of the smaller maternity units were not in a position to have their consultant covering the labour ward exclusively. An emergency delivery at night presented greater challenges, Prof Bonnar said, because an anaesthetist might not be on site, it was easier during daytime hours when the entire delivery team was present.