gms | German Medical Science

Background: In Germany, obstetrics is regarded as safe and of high quality [1]. However, Caesarean section rates exceed international recommendations and a rising number of healthy pregnant women receive unnecessary interventions [2]. In addition to individual biological conditions, factors inherent to the system such as size and structure of the hospital, care concepts and stuffing are deemed responsible [3], [4] for this situation as well as established correlations between daytime and delivery mode [5]. However, little research has been done into the extent to which shift times are related to birth mode.

Aim/Research Question: How do size oft the hospital, time of birth, stuffing of the delivery room and workload of the occupational groups relate to the delivery mode?

This research project aims to evaluate, how clinical work structures influence the quality of obstetric care to question the prevailing working processes and improve them for the mother and childs benefits.

Methods: Obstetrical data out of six hospitals in Hesse from 2018 being collected and analysed secondary by SPSS (Chi²-test; t-test). The time is divided into in-hours, meaning daytime, and off-hours, meaning evening, nighttime and weekends. Clinical structures are operationalized by the variables size oft he hospital, occupation, workload and on-call service.

Results: There is a clear correlation between the hospitals, their sizes, time of births and mode of delivery. In the in-hours, spontaneous births are less frequent and operative births are more frequent. In off-hours, more vaginal-instrumental births take place the larger the delivery unit is (P=0,000). The larger the hospital, the smaller are the differences between in-hours and off-hours. The more assistant doctors are available, the more often vaginal-instrumental births are performed (P=0,000). As the workload of midwives increases, the rates of vaginal-instrumental births decrease (P=0,005). There is also a connection between the workload of gynaecologists and secondary sections (P=0,019). The on-call service by a midwife also has an effect on the mode of delivery (P=0,002).

Relevance: Working structures and systems of the hospitals influence the delivery mode. The presented results can not solaly be explained biologically or medically.

Recommendations/Conclusion: In the context of quality assurance, the optimization of the prevailing conditions in the hospitals should be dealt with in detail. Further research is needed in larger surveys on differences in hospital structures, work processes and daytime and how they affect births, women and children.

It requires evidenzbased proofs of this malsitaution to support a new way of thinking in economic, political, social and individual terms.

Ethics and conflicts of interest: No vote on ethics was obtained. The research was financed by own resources. There are no conflicts of interest.