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Count the babies: what we learned

Count the babies: what we learned

Instigated by the Queensland Nurses & Midwives Union, ANMF (Vic Branch) along with the NSW and ACT branches participated in a ‘Count the babies’ audit of post-natal wards in Victorian public sector hospitals on 20 July 2022.

Babies on postnatal wards are not currently counted in ratios, effectively adding to the workload of midwives. The audit was designed to draw attention to this invisible workload, and ultimately to push for positive change. Statistics and quotes gathered from the audit may be provided to Department of Health and employers. It is also important data for the Branch in relation to our state election asks for maternity.

By not recognising or valuing the workload of all babies, qualified and unqualified, risks may include missed or delayed medications or observations, and the inability of midwives to provide:

  • education and support for breastfeeding
  • education and support for understanding the needs of a newborn
  • education and support for new parents
  • education and practice of settling techniques for when they are home
  • education and support for understanding of safe sleeping principles.

We also know that midwives are more likely than nurses to report working part time due to workloads, fatigue and distress at being unable to provide quality clinical care.

What the audit revealed

The audit was conducted over a 24-hour period, across all three shifts. Participating members were asked to provide a snapshot of their postnatal ward, including staffing levels, acuity, skill mix and whether they felt they were able to safely care for the patients/mothers and babies in the ward.

ANMF (Vic Branch) is pleased to report that at least one audit was completed for the majority of the 52 public sector post-natal services in the state, with many completing an audit for all three shifts. This is a huge testament to the commitment of our midwifery members, who we know despite extraordinary demand across many maternity services, still completed this important audit. We are continuing to analyse the data, but a quick snapshot reveals that on 20 July 2022, the numbers included:

  • women admitted to maternity wards for antenatal and post-natal care: 360
  • normal vaginal births: 76
  • caesarean sections: 154
  • women/birthing parents requiring additional support: 200
  • neonates on postnatal wards: 201
  • qualified babies: 12
  • unqualified babies: 189

What you said

In addition to the raw numbers, participants provided qualitative feedback, including:

  • ‘We are all doing our best every shift but there were no other midwives available for the shift as all were attending births in labour ward.’
  • ‘The three RNs and one midwife were also looking after 16 surgical patients.’
  • ‘Out of four midwives, three were grads. On many shifts there is only one midwife, [with] the balance made up of grads and students. Students on leave this week.’
  • ‘No mothers and babies today but on other days three mums and bubs that have to get cared for by RNs with no maternity training because the one midwife has to be in the birth suite.’
  • ‘Multiple babies should have gone to special care nursery but were unable due to the acuity of special care nursery and being over ratios there. Many babies had low sugars and required treatment multiple times and care was compromised as overall ratios were breached in all areas of maternity today.’

Initial observations/recommendations

The data within this audit appears to support the ANMF Federal Office position statement that:

  1. All newborns and their mothers require midwifery care.
  2. All newborns are admitted patients and should be recognised as a patient in their own right, requiring care separate to that of the mother/birthing parent.
  3. Maternity services must be staffed appropriately to ensure the provision of safe care to meet the needs of women and their newborns (qualified or unqualified).
  4. Maternity services are understaffed and do not have the staffing resources to manage the complexities in newborn care, thereby placing women, newborns and staff at risk.
  5. Newborns with complex needs that are managed within postnatal wards should qualify for funding and increased maternity staffing.
  6. The classification of newborns and the calculation of workloads in maternity services must be reviewed.

A ‘Count the Babies’ online forum is scheduled for Friday 19 August from 2pm to 3pm to report back in more detail to those nominated members who participated in the audit. Importantly, the next step is to determine what this data tells us about what exactly is needed for different maternity capability services in terms of staffing resources to appropriately meet the clinical needs of all the women and babies in their care.

The Branch will send a forum invitation via email and text to the nominated members who participated in the audit, along with maternity Job Reps in the public sector.