Evaluating the impact of staffing recommendations in maternity units in France

Sufficient midwifery staff is crucial to the quality of maternity care. However, the shortage of staff that France has been facing for several decades creates situations of understaffing. In order to determine the required number of midwives in a given department, several guidelines have been presented in the literature. Yet, we lack evidence on how these guidelines affect quality of care. The main objective of this study is to evaluate staffing guidelines provided by legal texts and the scientific literature. To do so, we observed a French public hospital maternity and built a discrete-event simulation model using Simul8 software. The simulation model reproduces the structure, staffing schedules and patient characteristics of the maternity. Because it has been shown that continuous support has a positive impact on service indicators, we used the supervision rate in labor as our main performance metric. Using this model, we analysed the impact of different staffing recommendations on quality of care measured by the continuous support ratio. The results highlight the impact of availability and staffing levels on continuous support during labour. The simulation approach can support trade-offs between ample slack in resources, which ensures that continuous support is always feasible, and tight staffing levels that lead to high workload.