The study took place on the labour wards of seven maternity units in the north west of England. The lead researcher observed the organisation of care on each labour ward, analysed records, and interviewed all midwives on duty.
All maternity units experienced midwifery staffing shortages and most units relied on bank midwives to maintain minimum staffing levels.
High-risk practices (such as giving drugs to induce labour and performing epidurals) continued during midwifery shortfalls in all units. Many adverse events and "near misses" were caused by these shortages, and near misses went unreported in all units. Staffing shortages also prevented uptake of scheduled training sessions.
"We observed many latent failures ("accidents waiting to happen") in this study," write the authors.
Despite the exemplary dedication of midwives, the system cannot operate safely and effectively when the number of midwives is inadequate, midwives are poorly deployed, and they are unable to undertake training and update their skills, they conclude.