Mattock Richard, Bojke Chris, Wright Judy, Stacey Tomasina
Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
Lumanity Inc, Sheffield, United Kingdom.
PLoS One. 2025 Aug 25;20(8):e0329117. doi: 10.1371/journal.pone.0329117. eCollection 2025.
Excessive midwifery workload is a growing concern that may affect safety and quality of care, with potential consequences for mothers and babies.
To assess how midwife workload affects delivery of care, and maternal and neonatal outcomes; and whether maternal, neonatal, and staffing factors modify these relationships.
This systematic review updated a prior review (January 1998 to June 2014) with revisions to search strategies. We searched for new evidence (June 2014 to October 2023) across 11 academic databases (Cochrane Database of Systematic Reviews (Wiley); Cochrane Central Register of Controlled Trials (Wiley); CINAHL (EBSCOhost); EconLit (EBSCOhost; Embase (Ovid); Epistemonikos; Health Management Information Consortium (Ovid); International HTA Database (INAHTA); Maternity & Infant Care Database (Ovid); Ovid MEDLINE(R); CEA Registry) and 10 grey literature websites. Screening involved multiple reviewers, with 10% of records independently double-screened. Inclusion criteria were intrapartum births in maternity wards in OECD countries, a measure of midwifery workload, and outcomes related to provision of care, mode of birth, and maternal or neonatal morbidity and mortality. A single reviewer conducted data extraction, bias assessments, and a narrative synthesis.
We included 23 studies (15 new, 8 from the original review) from the UK, USA, Italy, France, and Germany, covering 2,943,120 births. Only three studies were rated as high quality. Many outcomes showed no significant effects, or inconsistent effects across studies. High workload was significantly linked to care delays, increased instrumental and caesarean births, and some maternal outcomes (e.g., perineal trauma). Associations were modified by maternal characteristics, including clinical risk, parity, and civil status. No significant associations were found between workload and neonatal outcomes, except for one low-quality study reporting increased neonatal ward admissions.
High midwifery workload may alter care provision, potentially affecting mother and baby outcomes. Further robust research is needed to address limitations in current evidence.
助产士工作量过大日益受到关注，这可能会影响护理的安全性和质量，对母婴产生潜在影响。
评估助产士工作量如何影响护理的提供以及母婴结局；以及产妇、新生儿和人员配置因素是否会改变这些关系。
本系统评价更新了之前的评价（1998年1月至2014年6月），并对检索策略进行了修订。我们在11个学术数据库（Cochrane系统评价数据库（Wiley）；Cochrane对照试验中央注册库（Wiley）；护理学与健康照护数据库（EBSCOhost）；经济文献数据库（EBSCOhost）；Embase（Ovid）；Epistemonikos；健康管理信息联盟（Ovid）；国际卫生技术评估数据库（INAHTA）；母婴护理数据库（Ovid）；Ovid MEDLINE（R）；成本效果分析注册库）和10个灰色文献网站中搜索新证据（2014年6月至2023年10月）。筛选由多名评审员进行，10%的记录进行独立双盲筛选。纳入标准为经合组织国家产科病房的分娩期分娩、助产士工作量的衡量标准以及与护理提供、分娩方式、产妇或新生儿发病率和死亡率相关的结局。由一名评审员进行数据提取、偏倚评估和叙述性综合分析。
我们纳入了来自英国、美国、意大利、法国和德国的23项研究（15项新研究，8项来自原评价），涵盖2943120例分娩。只有三项研究被评为高质量。许多结局未显示出显著影响，或各研究之间的影响不一致。高工作量与护理延迟、器械助产和剖宫产增加以及一些产妇结局（如会阴创伤）显著相关。这些关联因产妇特征（包括临床风险、产次和婚姻状况）而有所改变。除一项低质量研究报告新生儿病房入院人数增加外，未发现工作量与新生儿结局之间存在显著关联。
助产士高工作量可能会改变护理提供方式，潜在影响母婴结局。需要进一步开展有力研究以解决当前证据中的局限性。
